Provider First Line Business Practice Location Address:
801 WASHINGTON AVENUE
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:
19147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-519-9353
Provider Business Practice Location Address Fax Number:
276-519-8120
Provider Enumeration Date:
02/26/2021