Provider First Line Business Practice Location Address:
3635 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:
19140-4255
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-907-7300
Provider Business Practice Location Address Fax Number:
215-827-5741
Provider Enumeration Date:
06/18/2013