Provider First Line Business Practice Location Address:
5846 NORTH 4TH 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:
19120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-538-8333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2016