Provider First Line Business Practice Location Address:
7500 GERMANTOWN AVE
Provider Second Line Business Practice Location Address:
NEW COVENANT CAMPUS ELDERS HALL SUITE 002A
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19119-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-247-6516
Provider Business Practice Location Address Fax Number:
215-247-0564
Provider Enumeration Date:
02/07/2007