Provider First Line Business Practice Location Address:
5830 HENRY 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:
19128-1754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-483-3800
Provider Business Practice Location Address Fax Number:
215-483-4414
Provider Enumeration Date:
05/06/2008