Provider First Line Business Practice Location Address:
1738 W CHELTENHAM 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:
19126-1546
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-548-3390
Provider Business Practice Location Address Fax Number:
215-549-8998
Provider Enumeration Date:
08/05/2006