Provider First Line Business Practice Location Address:
420 OLD YORK ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JENKINTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-572-1234
Provider Business Practice Location Address Fax Number:
215-572-1102
Provider Enumeration Date:
07/05/2006