Provider First Line Business Practice Location Address:
7532 HAVERFORD 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:
19151-2109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-479-7256
Provider Business Practice Location Address Fax Number:
215-878-1330
Provider Enumeration Date:
06/13/2006