Provider First Line Business Practice Location Address:
1916 WELSH RD
Provider Second Line Business Practice Location Address:
SUITE 1B
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19115-4655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-464-6663
Provider Business Practice Location Address Fax Number:
215-464-4949
Provider Enumeration Date:
03/13/2007