Provider First Line Business Practice Location Address:
7900 OLD YORK RD
Provider Second Line Business Practice Location Address:
SUITE 114A
Provider Business Practice Location Address City Name:
ELKENS PARK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-635-3249
Provider Business Practice Location Address Fax Number:
215-741-3843
Provider Enumeration Date:
11/29/2006