Provider First Line Business Practice Location Address:
2516 GERMANTOWN 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:
19133-1635
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-625-4312
Provider Business Practice Location Address Fax Number:
215-229-7954
Provider Enumeration Date:
08/24/2015