Provider First Line Business Practice Location Address:
8632 GERMANTOWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19118-2841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-247-0411
Provider Business Practice Location Address Fax Number:
215-248-3004
Provider Enumeration Date:
09/14/2006