Provider First Line Business Practice Location Address:
1306 COTTMAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19111-3606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-745-1212
Provider Business Practice Location Address Fax Number:
215-745-4427
Provider Enumeration Date:
07/20/2006