Provider First Line Business Practice Location Address:
2913 N 22ND 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:
19132-1505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-422-3109
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/05/2018