Provider First Line Business Practice Location Address:
8301 ROOSEVELT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19152-2006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-624-7575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2007