Provider First Line Business Practice Location Address:
9821 ACADEMY 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:
19114-1545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-632-8700
Provider Business Practice Location Address Fax Number:
215-632-5901
Provider Enumeration Date:
05/28/2006