Provider First Line Business Practice Location Address:
112 W CHELTEN 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:
19144-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-848-4651
Provider Business Practice Location Address Fax Number:
215-848-7817
Provider Enumeration Date:
07/29/2006