Provider First Line Business Practice Location Address:
7516 CASTOR 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:
19152-4002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-742-4250
Provider Business Practice Location Address Fax Number:
215-728-1389
Provider Enumeration Date:
04/02/2007