Provider First Line Business Practice Location Address:
1348 BAINBRIDGE STREET
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:
19147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-563-0652
Provider Business Practice Location Address Fax Number:
215-563-0664
Provider Enumeration Date:
07/13/2017