Provider First Line Business Practice Location Address:
5363 OXFORD 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:
19124-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-722-5080
Provider Business Practice Location Address Fax Number:
215-722-5082
Provider Enumeration Date:
05/30/2006