Provider First Line Business Practice Location Address:
12265 TOWNSEND 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:
19154-1201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-856-1303
Provider Business Practice Location Address Fax Number:
215-856-1300
Provider Enumeration Date:
06/30/2010