Provider First Line Business Practice Location Address:
3392 RED LION RD
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:
19114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-632-3074
Provider Business Practice Location Address Fax Number:
215-672-3373
Provider Enumeration Date:
07/02/2006