Provider First Line Business Practice Location Address:
3550 N 9TH 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:
19140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-516-6451
Provider Business Practice Location Address Fax Number:
215-689-1977
Provider Enumeration Date:
09/01/2016