Provider First Line Business Practice Location Address:
5911 LANCASTER 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:
19151-3538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-452-0178
Provider Business Practice Location Address Fax Number:
215-452-0179
Provider Enumeration Date:
09/23/2011