Provider First Line Business Practice Location Address:
216 W ROOSEVELT BLVD
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:
19120-4120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-329-4814
Provider Business Practice Location Address Fax Number:
215-329-4816
Provider Enumeration Date:
04/24/2008