Provider First Line Business Practice Location Address:
2520 N 2ND ST BLDG B
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:
19133-3464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-914-8834
Provider Business Practice Location Address Fax Number:
267-665-2320
Provider Enumeration Date:
09/03/2024