Provider First Line Business Practice Location Address:
7601 GERMANTOWN AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19119-1608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-753-1330
Provider Business Practice Location Address Fax Number:
215-753-1331
Provider Enumeration Date:
04/21/2015