Provider First Line Business Practice Location Address:
2415 N 33RD 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:
19132-2804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-225-6222
Provider Business Practice Location Address Fax Number:
215-225-6224
Provider Enumeration Date:
11/27/2012