Provider First Line Business Practice Location Address:
2661 AMBER 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:
19125-1403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-680-5790
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/10/2020