Provider First Line Business Practice Location Address:
6817 TORRESDALE AVE
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19135-2313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-332-0203
Provider Business Practice Location Address Fax Number:
215-332-0204
Provider Enumeration Date:
10/30/2009