Provider First Line Business Practice Location Address:
5401 OLD YORK RD STE 505
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:
19141-3047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-456-6970
Provider Business Practice Location Address Fax Number:
215-456-7154
Provider Enumeration Date:
03/26/2012