Provider First Line Business Practice Location Address:
8627 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:
19118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-331-7303
Provider Business Practice Location Address Fax Number:
215-242-5515
Provider Enumeration Date:
10/21/2009