Provider First Line Business Practice Location Address:
8815 GERMANTOWN AVENUE
Provider Second Line Business Practice Location Address:
5TH FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-248-8145
Provider Business Practice Location Address Fax Number:
215-248-8852
Provider Enumeration Date:
07/31/2012