Provider First Line Business Practice Location Address:
4641 ROOSEVELT BOULEVARD, SCATTERGOOD BLDG, SUITE E 218
Provider Second Line Business Practice Location Address:
DREXEL UNIVERSITY COLLEGE OF MEDICINE, FRIENDS HOSPITAL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-831-4041
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/23/2009