Provider First Line Business Practice Location Address:
2137 WELSH ROAD
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-676-7846
Provider Business Practice Location Address Fax Number:
215-676-9384
Provider Enumeration Date:
05/10/2006