Provider First Line Business Practice Location Address:
9456 STATE RD
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:
19114-3079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-632-8282
Provider Business Practice Location Address Fax Number:
215-632-8282
Provider Enumeration Date:
07/17/2006