Provider First Line Business Practice Location Address:
2900 GERMANTOWN 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:
19133-1832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-229-6454
Provider Business Practice Location Address Fax Number:
229-229-2508
Provider Enumeration Date:
11/22/2005