Provider First Line Business Practice Location Address:
1469 N 60TH 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:
19151-4204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-473-2030
Provider Business Practice Location Address Fax Number:
215-473-2031
Provider Enumeration Date:
02/25/2015