Provider First Line Business Practice Location Address:
6782 GERMANTOWN 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:
19119-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-506-0642
Provider Business Practice Location Address Fax Number:
267-502-3000
Provider Enumeration Date:
10/05/2015