Provider First Line Business Practice Location Address:
100 LANCASTER AVENUE
Provider Second Line Business Practice Location Address:
SUITE 253 LANKENAU MEDICAL BLDG. E
Provider Business Practice Location Address City Name:
WYNNEWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-642-8823
Provider Business Practice Location Address Fax Number:
610-896-2186
Provider Enumeration Date:
10/02/2006