Provider First Line Business Practice Location Address:
1511 CARPENTER 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:
19146-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-923-2690
Provider Business Practice Location Address Fax Number:
215-923-8940
Provider Enumeration Date:
04/16/2007