Provider First Line Business Practice Location Address:
5401 OLD YORK RD
Provider Second Line Business Practice Location Address:
WILLOWCREST BLDG, 4TH FL
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19141-3030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-456-3953
Provider Business Practice Location Address Fax Number:
215-456-5948
Provider Enumeration Date:
12/02/2008