Provider First Line Business Practice Location Address:
100 EAST LANKENAU AVENUE
Provider Second Line Business Practice Location Address:
LANKENAU MEDICAL CENTER, GROUND FLOOR, SUITE B5
Provider Business Practice Location Address City Name:
WYNNEWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-476-2638
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2010