Provider First Line Business Practice Location Address:
8815 GERMANTOWN AVE
Provider Second Line Business Practice Location Address:
SUITE 14
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19118-2722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-248-2600
Provider Business Practice Location Address Fax Number:
215-248-2606
Provider Enumeration Date:
10/29/2005