Provider First Line Business Practice Location Address: 
WORKHEALTH KNIGHTS & RED LION RDS
    Provider Second Line Business Practice Location Address: 
SUITE 206-MOB
    Provider Business Practice Location Address City Name: 
PHILADELPHIA
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
19114
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
215-612-4836
    Provider Business Practice Location Address Fax Number: 
215-612-4904
    Provider Enumeration Date: 
08/22/2006