Provider First Line Business Practice Location Address:
1244 FORT WASHINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
FORT WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19034-1743
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-542-1247
Provider Business Practice Location Address Fax Number:
215-542-7936
Provider Enumeration Date:
10/10/2005