BLAKE SHORE

PHILADELPHIA, PA
NPI1215867841
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy390200000X Student in an Organized Health Care Education/Training Program
Enumeration Date2026-05-25
Last Update Date2026-05-25
Business Address
BLAKE SHORE
240 S 40TH ST
PHILADELPHIA, PA 19104-6030
Phone number: 215-573-2588
Mailing Address
BLAKE SHORE
240 S 40TH ST
PHILADELPHIA, PA 19104-6030
Phone number: 215-573-2588
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