Provider First Line Business Practice Location Address:
8001 ROOSEVELT BLVD
Provider Second Line Business Practice Location Address:
SUITE# 503, SMYLIE TIMES BUILDING
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-268-9655
Provider Business Practice Location Address Fax Number:
215-338-1979
Provider Enumeration Date:
12/13/2006