Provider First Line Business Practice Location Address:
6808 TORRESDALE 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:
19135-2314
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-333-6444
Provider Business Practice Location Address Fax Number:
215-333-4275
Provider Enumeration Date:
09/26/2005