Provider First Line Business Practice Location Address:
338 E ALLEGHENY AVE
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:
19134-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-634-4397
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2021