Provider First Line Business Practice Location Address:
7632 CITY LINE 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:
19151-2007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-425-1500
Provider Business Practice Location Address Fax Number:
215-425-1659
Provider Enumeration Date:
12/17/2008