Provider First Line Business Practice Location Address:
4943 GERMANTOWN 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:
19144-5962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-991-9911
Provider Business Practice Location Address Fax Number:
215-991-9913
Provider Enumeration Date:
11/30/2006