Provider First Line Business Practice Location Address:
3998 RED LION ROAD
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:
19053-1436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-595-1100
Provider Business Practice Location Address Fax Number:
612-294-4903
Provider Enumeration Date:
04/06/2006