Provider First Line Business Practice Location Address:
424 S 61ST 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:
19143-1036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-727-0727
Provider Business Practice Location Address Fax Number:
215-727-0728
Provider Enumeration Date:
06/01/2018