Provider First Line Business Practice Location Address:
1701 N 13TH ST
Provider Second Line Business Practice Location Address:
TEMPLE UNIVERSITY, WEISS HALL PSYCHOLOGY
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19122-6011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-204-4296
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/05/2012