Provider First Line Business Practice Location Address:
SUITE 161, LANKENAU MEDICAL BLDG EAST
Provider Second Line Business Practice Location Address:
100 EAST LANCASTER AVENUE
Provider Business Practice Location Address City Name:
WYNNEWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19096-3425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-642-5371
Provider Business Practice Location Address Fax Number:
610-642-5658
Provider Enumeration Date:
12/11/2006