Provider First Line Business Practice Location Address:
2726 HOLME AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19152-3011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-335-0130
Provider Business Practice Location Address Fax Number:
215-335-0653
Provider Enumeration Date:
04/21/2010