Provider First Line Business Practice Location Address:
2248 KIMBALL 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:
19146-2524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-606-8537
Provider Business Practice Location Address Fax Number:
215-884-3718
Provider Enumeration Date:
10/31/2016