Provider First Line Business Practice Location Address:
9389 KREWSTOWN RD
Provider Second Line Business Practice Location Address:
NORTHEAST RACQUET CLUB & FITNESS CENTER
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19115-3710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-676-6760
Provider Business Practice Location Address Fax Number:
215-676-3746
Provider Enumeration Date:
05/11/2006