Provider First Line Business Practice Location Address:
5814 RISING SUN AVE
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:
19120-1126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-745-4949
Provider Business Practice Location Address Fax Number:
215-342-8821
Provider Enumeration Date:
09/27/2006