Provider First Line Business Practice Location Address:
8115 RIDGE 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:
19128-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-487-2347
Provider Business Practice Location Address Fax Number:
215-487-1459
Provider Enumeration Date:
01/11/2011