Provider First Line Business Practice Location Address:
1701 A GRANT 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:
19115-3160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-464-3838
Provider Business Practice Location Address Fax Number:
215-464-3899
Provider Enumeration Date:
07/16/2008