Provider First Line Business Practice Location Address:
700 ROBBINS AVE
Provider Second Line Business Practice Location Address:
DEFENSE SUPPLY CENTER PHILA-MEDICAL DIRECTORATE BLD 6A
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19111-5096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-737-5772
Provider Business Practice Location Address Fax Number:
215-737-4113
Provider Enumeration Date:
02/28/2006