Provider First Line Business Practice Location Address:
5616 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:
19144-2228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-383-9800
Provider Business Practice Location Address Fax Number:
215-383-0115
Provider Enumeration Date:
08/26/2013