Provider First Line Business Practice Location Address:
7625 OGONTZ AVE
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:
19150-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-224-9515
Provider Business Practice Location Address Fax Number:
215-224-4388
Provider Enumeration Date:
09/21/2009