Provider First Line Business Practice Location Address:
BELMONT CENTER
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:
19131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-581-9142
Provider Business Practice Location Address Fax Number:
215-581-3827
Provider Enumeration Date:
10/27/2006