Provider First Line Business Practice Location Address:
1315 WINDRIM 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:
19141-2710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-599-2848
Provider Business Practice Location Address Fax Number:
215-599-1041
Provider Enumeration Date:
11/14/2006