Provider First Line Business Practice Location Address:
3206 HENRY 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:
19129-1238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-849-4300
Provider Business Practice Location Address Fax Number:
215-849-4308
Provider Enumeration Date:
12/27/2006