Provider First Line Business Practice Location Address:
3336 ALDINE 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:
19136-3802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-333-2408
Provider Business Practice Location Address Fax Number:
215-332-5370
Provider Enumeration Date:
07/19/2006