Provider First Line Business Practice Location Address:
2515 E CLEARFIELD 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:
19134-5017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-912-7354
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/12/2025