Provider First Line Business Practice Location Address:
6400 GERMANTOWN 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:
19119-2343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-649-8136
Provider Business Practice Location Address Fax Number:
610-649-4270
Provider Enumeration Date:
12/22/2006