Provider First Line Business Practice Location Address:
6364 GERMANTOWN 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:
19144-1992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-259-7338
Provider Business Practice Location Address Fax Number:
267-259-7338
Provider Enumeration Date:
03/02/2026