Provider First Line Business Practice Location Address:
8945 RIDGE AVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19128-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-508-3291
Provider Business Practice Location Address Fax Number:
215-508-3022
Provider Enumeration Date:
12/30/2006