Provider First Line Business Practice Location Address:
12311 ACADEMY RD
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:
19154-1927
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-637-4690
Provider Business Practice Location Address Fax Number:
215-637-6121
Provider Enumeration Date:
05/05/2010