Provider First Line Business Practice Location Address:
2601 HOLME 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:
19152-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-335-6198
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2007