Provider First Line Business Practice Location Address:
1348-50 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-236-1210
Provider Business Practice Location Address Fax Number:
215-236-1080
Provider Enumeration Date:
07/26/2010