Provider First Line Business Practice Location Address:
2522 W HUNTINGDON 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:
19132-3633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-225-4626
Provider Business Practice Location Address Fax Number:
215-225-4634
Provider Enumeration Date:
02/27/2007