Provider First Line Business Practice Location Address:
3905 FORD RD
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:
19131-2824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-473-5709
Provider Business Practice Location Address Fax Number:
215-473-6522
Provider Enumeration Date:
04/05/2006