Provider First Line Business Practice Location Address:
5401 OLD YORK RD
Provider Second Line Business Practice Location Address:
KLEIN PROF BLDG STE 403
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19141-3030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-457-0700
Provider Business Practice Location Address Fax Number:
215-457-0419
Provider Enumeration Date:
03/13/2008