Provider First Line Business Practice Location Address:
900 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:
19124-3128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-537-2701
Provider Business Practice Location Address Fax Number:
215-537-2693
Provider Enumeration Date:
06/06/2016