Provider First Line Business Practice Location Address:
5225 GERMANTOWN 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:
19144-2301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-225-5437
Provider Business Practice Location Address Fax Number:
215-229-3361
Provider Enumeration Date:
04/15/2011