Provider First Line Business Practice Location Address:
3212 W CHELTENHAM 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:
19150-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-885-1200
Provider Business Practice Location Address Fax Number:
215-885-8807
Provider Enumeration Date:
06/13/2007