Provider First Line Business Practice Location Address:
2323 MEMPHIS 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:
19143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
445-233-1647
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2026