Provider First Line Business Practice Location Address:
12400 ACADEMY RD
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:
19154-1929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-637-6111
Provider Business Practice Location Address Fax Number:
215-637-6111
Provider Enumeration Date:
05/11/2007