Provider First Line Business Practice Location Address:
2990 HOLME 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:
19136-1830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-335-2100
Provider Business Practice Location Address Fax Number:
215-331-9105
Provider Enumeration Date:
12/01/2005