Provider First Line Business Practice Location Address:
706 W GIRARD 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:
19123-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-925-6848
Provider Business Practice Location Address Fax Number:
215-925-6846
Provider Enumeration Date:
04/25/2007