Provider First Line Business Practice Location Address:
6810 RIDGE 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:
19128-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-483-6550
Provider Business Practice Location Address Fax Number:
215-483-9079
Provider Enumeration Date:
11/16/2006