Provider First Line Business Practice Location Address:
7248 ELMWOOD 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:
19142-1533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-531-4178
Provider Business Practice Location Address Fax Number:
267-292-2936
Provider Enumeration Date:
05/07/2014