Provider First Line Business Practice Location Address:
5735 RIDGE AVE
Provider Second Line Business Practice Location Address:
STE 210
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19128-1745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-483-9610
Provider Business Practice Location Address Fax Number:
215-483-9679
Provider Enumeration Date:
08/09/2005