Provider First Line Business Practice Location Address:
7600 CENTRAL 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:
19111-2442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-728-3736
Provider Business Practice Location Address Fax Number:
215-728-3354
Provider Enumeration Date:
09/13/2006