Provider First Line Business Practice Location Address:
2821 ISLAND 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:
19153-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-365-1033
Provider Business Practice Location Address Fax Number:
215-365-1145
Provider Enumeration Date:
08/31/2005