Provider First Line Business Practice Location Address:
2417 WELSH RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19114-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-335-4416
Provider Business Practice Location Address Fax Number:
215-338-4426
Provider Enumeration Date:
06/30/2014