Provider First Line Business Practice Location Address:
120 ARDMORE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARDMORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19003-1315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-649-8136
Provider Business Practice Location Address Fax Number:
610-649-4270
Provider Enumeration Date:
12/22/2006