Provider First Line Business Practice Location Address:
3226 W CHELTENHAM 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:
19150-1003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-242-2202
Provider Business Practice Location Address Fax Number:
215-242-2203
Provider Enumeration Date:
06/19/2007