Provider First Line Business Practice Location Address:
861 E ALLEGHENY 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:
19134-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-302-3600
Provider Business Practice Location Address Fax Number:
215-329-2369
Provider Enumeration Date:
06/11/2024