Provider First Line Business Practice Location Address:
1520 SNYDER 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:
19145-3937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-462-2610
Provider Business Practice Location Address Fax Number:
215-462-0445
Provider Enumeration Date:
08/18/2006