Provider First Line Business Practice Location Address:
3601 A ST
Provider Second Line Business Practice Location Address:
OFFICE OF MEDICAL AND ACADEMIC AFFAIR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-1043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-427-5127
Provider Business Practice Location Address Fax Number:
215-427-4805
Provider Enumeration Date:
06/24/2009