Provider First Line Business Practice Location Address:
6705 OLD YORK RD
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:
19126-2841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-224-2137
Provider Business Practice Location Address Fax Number:
215-224-9164
Provider Enumeration Date:
03/27/2007