Provider First Line Business Practice Location Address:
7042 ELMWOOD 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:
19142-1722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-937-0700
Provider Business Practice Location Address Fax Number:
512-937-0164
Provider Enumeration Date:
06/18/2008