Provider First Line Business Practice Location Address:
2716 ORTHODOX ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19137-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-743-8848
Provider Business Practice Location Address Fax Number:
215-743-8750
Provider Enumeration Date:
02/24/2015