Provider First Line Business Practice Location Address:
5600 CITY AVE
Provider Second Line Business Practice Location Address:
SAINT JOSEPH'S UNIVERSITY, STUDENT HEALTH CENTER
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19131-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-660-1175
Provider Business Practice Location Address Fax Number:
610-660-3378
Provider Enumeration Date:
11/13/2008