Provider First Line Business Practice Location Address:
4711 WELLINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19135-1320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-333-6000
Provider Business Practice Location Address Fax Number:
215-333-5050
Provider Enumeration Date:
09/27/2006