Provider First Line Business Practice Location Address:
800 W MOYAMENSING 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:
19148-3709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-334-1833
Provider Business Practice Location Address Fax Number:
215-334-5046
Provider Enumeration Date:
05/26/2010