Provider First Line Business Practice Location Address:
1200 W GODFREY 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:
19141-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-276-6000
Provider Business Practice Location Address Fax Number:
215-276-1329
Provider Enumeration Date:
07/22/2026