Provider First Line Business Practice Location Address:
3900 WOODLAND 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:
19104-4551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-823-6365
Provider Business Practice Location Address Fax Number:
215-823-4407
Provider Enumeration Date:
10/24/2006