Provider First Line Business Practice Location Address:
RED LION ROAD AND KNIGHTS ROAD
Provider Second Line Business Practice Location Address:
NUTRITION CENTER
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-612-4863
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2006