Provider First Line Business Practice Location Address:
6800 CASTOR AVE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19149-2100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-904-8748
Provider Business Practice Location Address Fax Number:
215-904-8691
Provider Enumeration Date:
08/27/2009