Provider First Line Business Practice Location Address:
5600 CITY AVE
Provider Second Line Business Practice Location Address:
SPORTS MEDICINE
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19131-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-660-1699
Provider Business Practice Location Address Fax Number:
610-660-2577
Provider Enumeration Date:
10/18/2006