Provider First Line Business Practice Location Address:
4041 LANCASTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-387-7100
Provider Business Practice Location Address Fax Number:
215-592-0518
Provider Enumeration Date:
11/27/2006