Provider First Line Business Practice Location Address:
109 JENKINS AVE
Provider Second Line Business Practice Location Address:
LANSDALE CLUBHOUSE
Provider Business Practice Location Address City Name:
LANSDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19446-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-362-2887
Provider Business Practice Location Address Fax Number:
215-362-8894
Provider Enumeration Date:
04/11/2007