Provider First Line Business Practice Location Address:
5537 GERMANTOWN AVE FL 1
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:
19144-2225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-991-6222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2009