Provider First Line Business Practice Location Address:
8000 ESSINGTON AVE
Provider Second Line Business Practice Location Address:
TERMINAL A EAST 2ND FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19153-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-492-2789
Provider Business Practice Location Address Fax Number:
215-492-2770
Provider Enumeration Date:
02/23/2017