Provider First Line Business Practice Location Address:
BLOOMINGDALE PSYCHOLOGICAL SERVICES BUILDING
Provider Second Line Business Practice Location Address:
141 WEST WAYNE AVE
Provider Business Practice Location Address City Name:
WAYNE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-687-8901
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/05/2007