Provider First Line Business Practice Location Address:
4925 N 5TH 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:
19120-3809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-690-5400
Provider Business Practice Location Address Fax Number:
215-690-5670
Provider Enumeration Date:
09/26/2022