Provider First Line Business Practice Location Address:
1926 E WASHINGTON LN
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:
19138-1230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-927-4467
Provider Business Practice Location Address Fax Number:
215-927-4469
Provider Enumeration Date:
04/10/2007