Provider First Line Business Practice Location Address:
422 PARLIN ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19116-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-823-5465
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2016