Provider First Line Business Practice Location Address:
8226 ARDLEIGH ST
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:
19118-3414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-547-7174
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2006