Provider First Line Business Practice Location Address:
3300 HENRY AVE
Provider Second Line Business Practice Location Address:
ONE FALLS CENTER
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19129-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-842-7415
Provider Business Practice Location Address Fax Number:
215-848-1355
Provider Enumeration Date:
03/24/2009