Provider First Line Business Practice Location Address: 
3998 RED LION RD
    Provider Second Line Business Practice Location Address: 
EMERGENCY MEDICINE
    Provider Business Practice Location Address City Name: 
PHILADELPHIA
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
19114-1436
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
215-612-4000
    Provider Business Practice Location Address Fax Number: 
215-807-8235
    Provider Enumeration Date: 
09/20/2005