Provider First Line Business Practice Location Address:
3324 MIDVALE AVE
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:
19129-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-849-5077
Provider Business Practice Location Address Fax Number:
215-849-8787
Provider Enumeration Date:
11/07/2006