Provider First Line Business Practice Location Address:
542 E GIRARD 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:
19125-3331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-423-6090
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/03/2006