Provider First Line Business Practice Location Address:
2627 GERMANTOWN AVE
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:
19133-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-228-8723
Provider Business Practice Location Address Fax Number:
215-221-6169
Provider Enumeration Date:
09/17/2020