Provider First Line Business Practice Location Address:
2981 GRANT 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:
19114-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-632-4550
Provider Business Practice Location Address Fax Number:
215-632-7865
Provider Enumeration Date:
08/01/2006