Provider First Line Business Practice Location Address:
6104 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:
19144-2048
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-387-4288
Provider Business Practice Location Address Fax Number:
215-387-4360
Provider Enumeration Date:
03/07/2007