Provider First Line Business Practice Location Address:
6546 TORRESDALE 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:
19135-2822
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-624-1998
Provider Business Practice Location Address Fax Number:
215-624-2105
Provider Enumeration Date:
09/07/2005