Provider First Line Business Practice Location Address:
720 KATER ST APT 1F
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:
19147-2075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-745-6119
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/28/2023