Provider First Line Business Practice Location Address:
3900 CITY AVE
Provider Second Line Business Practice Location Address:
PRESIDENTIAL-MADISON HOUSE, SUITE D-105
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19131-2908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-472-6454
Provider Business Practice Location Address Fax Number:
215-878-4622
Provider Enumeration Date:
09/06/2006