Provider First Line Business Practice Location Address:
2137 WELSH RD
Provider Second Line Business Practice Location Address:
SUITE 2A
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19115-4963
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-676-0717
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007