Provider First Line Business Practice Location Address:
421 W SCHOOL HOUSE LN UNIT 2
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:
19144-4557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-477-1421
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2013