Provider First Line Business Practice Location Address:
7201 RISING SUN AVENUE
Provider Second Line Business Practice Location Address:
EINSTEIN PLAZA RISING SUN
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-745-3525
Provider Business Practice Location Address Fax Number:
215-745-1088
Provider Enumeration Date:
07/24/2007