Provider First Line Business Practice Location Address:
3910 POWELTON AVENUE
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104-2692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-662-9496
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/02/2009