Provider First Line Business Practice Location Address:
6140 N 20TH 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:
19138-2419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-901-5305
Provider Business Practice Location Address Fax Number:
215-561-4677
Provider Enumeration Date:
12/30/2024