Provider First Line Business Practice Location Address:
2236 FAIRMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA.
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19130-2617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-232-6030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/09/2008