Provider First Line Business Practice Location Address:
6445 RISING SUN 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:
19111-5228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-742-7889
Provider Business Practice Location Address Fax Number:
215-742-6199
Provider Enumeration Date:
07/07/2005