Provider First Line Business Practice Location Address:
2938 N 22ND 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:
19132-1504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-518-0466
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2013