Provider First Line Business Practice Location Address:
1940 E WALNUT LN
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:
19138-1312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-548-2113
Provider Business Practice Location Address Fax Number:
215-548-3009
Provider Enumeration Date:
05/25/2006