Provider First Line Business Practice Location Address:
7258 BRADFORD 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:
19149-1303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-332-8051
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/27/2007