Provider First Line Business Practice Location Address:
1217 FITZWATER ST.
Provider Second Line Business Practice Location Address:
UNIT A
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
609-634-7312
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/02/2017