Provider First Line Business Practice Location Address:
3998 RED LION RD
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:
19114-1445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-612-4088
Provider Business Practice Location Address Fax Number:
215-612-4323
Provider Enumeration Date:
06/27/2005