Individual
ALFONZO POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1905 W SUSQUEHANNA AVE, PHILADELPHIA, PA 19121-1547
(267) 231-6586
Mailing address
PO BOX 50562, PHILADELPHIA, PA 19132-6562
(267) 231-6586
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
33813601
PA
Other
Enumeration date
10/01/2018
Last updated
10/01/2018
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