Provider First Line Business Practice Location Address:
7145 GERMANTOWN AVENUE
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:
19119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-247-1427
Provider Business Practice Location Address Fax Number:
267-297-5169
Provider Enumeration Date:
05/15/2015