Provider First Line Business Practice Location Address: 
10800 KNIGHTS RD
    Provider Second Line Business Practice Location Address: 
ATTN: RADIOLOGY
    Provider Business Practice Location Address City Name: 
PHILADELPHIA
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
19114-4200
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
215-612-2610
    Provider Business Practice Location Address Fax Number: 
215-612-5077
    Provider Enumeration Date: 
08/03/2006