Provider First Line Business Practice Location Address:
6535 RISING SUN 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:
19111-5246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-725-4740
Provider Business Practice Location Address Fax Number:
215-725-4742
Provider Enumeration Date:
04/23/2010