Provider First Line Business Practice Location Address:
1221 N 56TH 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:
19131-4224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-441-6444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2024