Provider First Line Business Practice Location Address:
14 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:
19118-3308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-382-3448
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2023