Provider First Line Business Practice Location Address:
2129 W OREGON AVE
Provider Second Line Business Practice Location Address:
3RD FLOOR SUITE
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19145-4131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-336-6630
Provider Business Practice Location Address Fax Number:
215-336-3928
Provider Enumeration Date:
05/15/2006