Provider First Line Business Practice Location Address:
6327 BURBRIDGE 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:
19144-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-991-9066
Provider Business Practice Location Address Fax Number:
215-991-9062
Provider Enumeration Date:
04/12/2016