Provider First Line Business Practice Location Address:
5338 BALTIMORE 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:
19143-3117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-476-2122
Provider Business Practice Location Address Fax Number:
215-476-6863
Provider Enumeration Date:
03/19/2007