Provider First Line Business Practice Location Address:
1451 N ORKNEY 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:
19122-3725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-831-9373
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2026