Provider First Line Business Practice Location Address:
7140 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:
19119-1843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-753-9034
Provider Business Practice Location Address Fax Number:
215-753-9035
Provider Enumeration Date:
10/01/2024