Provider First Line Business Practice Location Address:
6701 RIDGE 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:
19128-2459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-483-4179
Provider Business Practice Location Address Fax Number:
401-770-7108
Provider Enumeration Date:
03/22/2010