Provider First Line Business Practice Location Address:
3617 LANCASTER 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:
19104-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-387-1470
Provider Business Practice Location Address Fax Number:
215-222-3720
Provider Enumeration Date:
07/30/2008