Provider First Line Business Practice Location Address:
6138 WASHINGTON AVE STE B1
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:
19143-2915
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-366-2522
Provider Business Practice Location Address Fax Number:
215-747-1021
Provider Enumeration Date:
06/22/2021