Provider First Line Business Practice Location Address:
5575 OLD YORK RD
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:
19141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-437-9043
Provider Business Practice Location Address Fax Number:
215-437-9045
Provider Enumeration Date:
09/09/2014