Provider First Line Business Practice Location Address:
2300A REAR OREGON 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:
19145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-462-0297
Provider Business Practice Location Address Fax Number:
215-339-5897
Provider Enumeration Date:
06/07/2006