Provider First Line Business Practice Location Address:
7622 OGONTZ 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:
19150-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-893-4700
Provider Business Practice Location Address Fax Number:
215-893-4704
Provider Enumeration Date:
08/24/2006