Provider First Line Business Practice Location Address:
2215 N AMERICAN STREET
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:
19133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-425-6203
Provider Business Practice Location Address Fax Number:
215-425-6204
Provider Enumeration Date:
10/09/2014