Provider First Line Business Practice Location Address:
10700 KNIGHTS RD
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:
19114-4242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-637-2077
Provider Business Practice Location Address Fax Number:
215-637-2079
Provider Enumeration Date:
10/22/2008