Provider First Line Business Practice Location Address:
9600 ROOSEVELT BOULEVARD
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:
19115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-969-5122
Provider Business Practice Location Address Fax Number:
215-332-5228
Provider Enumeration Date:
12/05/2006