Provider First Line Business Practice Location Address:
7143 CLARIDGE 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:
19111-4001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-243-1171
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2025