Provider First Line Business Practice Location Address:
7932 GERMANTOWN AVE
Provider Second Line Business Practice Location Address:
(REAR OFFICE SUITE)
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19118-3511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-247-6464
Provider Business Practice Location Address Fax Number:
610-519-4050
Provider Enumeration Date:
11/27/2006