Provider First Line Business Practice Location Address:
2900 SOUTHAMPTON 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:
19154-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-671-5288
Provider Business Practice Location Address Fax Number:
215-671-7581
Provider Enumeration Date:
02/17/2009