Provider First Line Business Practice Location Address:
7127 GERMANTOWN AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19119-1855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-240-1449
Provider Business Practice Location Address Fax Number:
215-240-7012
Provider Enumeration Date:
10/19/2006