Provider First Line Business Practice Location Address:
1580 FORT WASHINGTON AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAPLE GLEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-643-8800
Provider Business Practice Location Address Fax Number:
215-643-8982
Provider Enumeration Date:
05/03/2007