Provider First Line Business Practice Location Address:
858 E WELSH RD
Provider Second Line Business Practice Location Address:
SUITE 12
Provider Business Practice Location Address City Name:
MAPLE GLEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19002-2942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-542-0460
Provider Business Practice Location Address Fax Number:
215-542-9058
Provider Enumeration Date:
12/20/2006