Provider First Line Business Practice Location Address:
4600 ROOSEVELT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19124-2340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-288-8900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2011