Provider First Line Business Practice Location Address:
5401 OLD YORK RD BLDG SUITE410
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:
19141-3030
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-456-6990
Provider Business Practice Location Address Fax Number:
215-456-6967
Provider Enumeration Date:
06/17/2008