Provider First Line Business Practice Location Address:
723 RED LION RD
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:
19115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-673-2522
Provider Business Practice Location Address Fax Number:
215-677-1083
Provider Enumeration Date:
07/04/2006