Provider First Line Business Practice Location Address:
2945-47 N. 5TH STREET
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-288-3653
Provider Business Practice Location Address Fax Number:
215-790-6257
Provider Enumeration Date:
10/25/2018