Provider First Line Business Practice Location Address:
6341 RIDGE 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:
19128-2527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-825-9360
Provider Business Practice Location Address Fax Number:
610-825-4127
Provider Enumeration Date:
02/23/2007