Provider First Line Business Practice Location Address:
1104 WELSH ROAD
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:
19115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-676-9191
Provider Business Practice Location Address Fax Number:
215-856-9560
Provider Enumeration Date:
04/23/2007