Provider First Line Business Practice Location Address:
7602 CENTRAL AVE
Provider Second Line Business Practice Location Address:
STAPLEY BLDG ST 103
Provider Business Practice Location Address City Name:
PHILLA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19111-2443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-745-7411
Provider Business Practice Location Address Fax Number:
215-745-7488
Provider Enumeration Date:
06/12/2012