Provider First Line Business Practice Location Address:
3801 05 LANCASTER 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:
19104-2317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-382-4300
Provider Business Practice Location Address Fax Number:
215-382-3972
Provider Enumeration Date:
01/29/2007