Provider First Line Business Practice Location Address:
7601 GERMANTOWN 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:
19119-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-248-6090
Provider Business Practice Location Address Fax Number:
215-248-6091
Provider Enumeration Date:
08/01/2006