Provider First Line Business Practice Location Address:
5100 GERMANTOWN 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:
19144-2327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-844-1319
Provider Business Practice Location Address Fax Number:
215-438-3947
Provider Enumeration Date:
07/10/2006