Provider First Line Business Practice Location Address:
7636 CITY LINE 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:
19151-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-594-8622
Provider Business Practice Location Address Fax Number:
215-473-8525
Provider Enumeration Date:
04/28/2016