Provider First Line Business Practice Location Address:
6112 TORRESDALE 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:
19135-3718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-333-7437
Provider Business Practice Location Address Fax Number:
215-333-9558
Provider Enumeration Date:
03/15/2007