Provider First Line Business Practice Location Address:
7715 WHITAKER 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:
19111-2854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-342-2225
Provider Business Practice Location Address Fax Number:
215-342-3232
Provider Enumeration Date:
01/18/2006