Provider First Line Business Practice Location Address:
6656 GERMANTOWN AVE STE 1
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:
19119-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-842-5939
Provider Business Practice Location Address Fax Number:
215-842-5937
Provider Enumeration Date:
08/21/2025