Provider First Line Business Practice Location Address:
5249 CEDAR AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19143-1524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-471-1817
Provider Business Practice Location Address Fax Number:
215-471-5089
Provider Enumeration Date:
11/15/2006