Provider First Line Business Practice Location Address:
1628 E WADSWORTH AVE
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:
19150-1020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-248-5700
Provider Business Practice Location Address Fax Number:
215-248-5702
Provider Enumeration Date:
04/25/2007