Provider First Line Business Practice Location Address:
240 W SCHOOL HOUSE LN FL 1
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:
19144-3927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-971-6203
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2025