Provider First Line Business Practice Location Address:
104 W CHELTENHAM 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:
19120-1027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-924-2521
Provider Business Practice Location Address Fax Number:
215-924-2367
Provider Enumeration Date:
12/26/2005