Provider First Line Business Practice Location Address:
9 E HIGHLAND 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:
19118-3307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-247-4660
Provider Business Practice Location Address Fax Number:
215-248-5739
Provider Enumeration Date:
02/20/2014