Provider First Line Business Practice Location Address:
2101 S COLUMBUS BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19148-2805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-467-4431
Provider Business Practice Location Address Fax Number:
215-467-8879
Provider Enumeration Date:
08/03/2005