Provider First Line Business Practice Location Address:
1900 WEST OLNEY AVE, BOX 271
Provider Second Line Business Practice Location Address:
LA SALLE UNIVERSITY
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-991-3518
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/08/2007