Provider First Line Business Practice Location Address:
2401 S 67TH STREET
Provider Second Line Business Practice Location Address:
JOHN BARTRAM HIGH SCHOOL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-492-6450
Provider Business Practice Location Address Fax Number:
215-492-2324
Provider Enumeration Date:
04/05/2006