Provider First Line Business Practice Location Address:
9500 NORTHEAST 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:
19115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-673-9500
Provider Business Practice Location Address Fax Number:
215-671-1112
Provider Enumeration Date:
08/19/2006