Provider First Line Business Practice Location Address:
7228 GERMANTOWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19119-1724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-248-6070
Provider Business Practice Location Address Fax Number:
215-248-2410
Provider Enumeration Date:
01/25/2007