Provider First Line Business Practice Location Address:
10000 ROOSEVELT BLVD STE C
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:
19116-3904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-676-0222
Provider Business Practice Location Address Fax Number:
215-676-0224
Provider Enumeration Date:
08/01/2013