Provider First Line Business Practice Location Address:
6035 CASTOR AVE
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:
19149-3207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-744-3800
Provider Business Practice Location Address Fax Number:
215-744-3803
Provider Enumeration Date:
06/22/2012