Provider First Line Business Practice Location Address:
298 WISSAHICKON AVENUE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
NORTH WALES
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-699-1009
Provider Business Practice Location Address Fax Number:
215-699-1022
Provider Enumeration Date:
05/28/2008