Provider First Line Business Practice Location Address:
2417 WELSH RD
Provider Second Line Business Practice Location Address:
204
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19114-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-676-2080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2006