Provider First Line Business Practice Location Address:
9815 ROOSEVELT BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19114-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-342-4400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/26/2010