Provider First Line Business Practice Location Address:
3939 GERMANTOWN AVE
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:
19140-3423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-239-2259
Provider Business Practice Location Address Fax Number:
267-239-2103
Provider Enumeration Date:
02/27/2019