Provider First Line Business Practice Location Address:
6613 CHEW 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:
19119-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-848-1166
Provider Business Practice Location Address Fax Number:
215-842-0224
Provider Enumeration Date:
11/16/2007