Provider First Line Business Practice Location Address:
7500 CENTRAL AVENUE
Provider Second Line Business Practice Location Address:
SUITE 100, PHYSICIANS OFFICE BUILDING
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-728-2020
Provider Business Practice Location Address Fax Number:
215-728-2044
Provider Enumeration Date:
02/21/2007