Provider First Line Business Practice Location Address:
2256 MOUNT CARMEL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENSIDE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19038-4610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-576-1321
Provider Business Practice Location Address Fax Number:
215-886-6892
Provider Enumeration Date:
01/24/2011