Provider First Line Business Practice Location Address:
259 S 60TH ST
Provider Second Line Business Practice Location Address:
1ST FL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-254-5155
Provider Business Practice Location Address Fax Number:
215-254-5110
Provider Enumeration Date:
04/23/2018