Provider First Line Business Practice Location Address:
2445 RIDGE 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:
19121-3013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-232-1021
Provider Business Practice Location Address Fax Number:
215-232-1023
Provider Enumeration Date:
04/16/2007