Provider First Line Business Practice Location Address:
7300 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:
19119-1725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-242-3912
Provider Business Practice Location Address Fax Number:
215-242-5567
Provider Enumeration Date:
10/09/2005