Provider First Line Business Practice Location Address:
8835 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:
19118-2718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-224-5678
Provider Business Practice Location Address Fax Number:
302-224-2848
Provider Enumeration Date:
12/11/2006