Provider First Line Business Practice Location Address: 
130 S BRYN MAWR AVE
    Provider Second Line Business Practice Location Address: 
BRYN MAWR HOSPITAL
    Provider Business Practice Location Address City Name: 
BRYN MAWR
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
19010-3121
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
302-651-4000
    Provider Business Practice Location Address Fax Number: 
302-651-4945
    Provider Enumeration Date: 
06/22/2006