Provider First Line Business Practice Location Address:
6715 OLD YORK 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:
19126-2841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-927-3778
Provider Business Practice Location Address Fax Number:
215-927-3745
Provider Enumeration Date:
07/09/2008