Provider First Line Business Practice Location Address:
4979 OLD STREET RD
Provider Second Line Business Practice Location Address:
SURGERY CENTER
Provider Business Practice Location Address City Name:
TREVOSE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19053-6222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-684-6065
Provider Business Practice Location Address Fax Number:
215-933-3120
Provider Enumeration Date:
04/09/2012