Provider First Line Business Practice Location Address:
8423 RIDGEWAY ST
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:
19111-1356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-725-5086
Provider Business Practice Location Address Fax Number:
215-941-6247
Provider Enumeration Date:
11/27/2007