Provider First Line Business Practice Location Address:
4900 WYALUSING AVE
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:
19131-5127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-473-7033
Provider Business Practice Location Address Fax Number:
215-878-9199
Provider Enumeration Date:
12/12/2006