Provider First Line Business Practice Location Address:
2385 W CHELTENHAM AVE
Provider Second Line Business Practice Location Address:
CHELTENHAM SQUARE MALL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19150-1506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-886-8316
Provider Business Practice Location Address Fax Number:
215-886-6722
Provider Enumeration Date:
03/14/2007