Provider First Line Business Practice Location Address:
2501 S 63RD ST
Provider Second Line Business Practice Location Address:
THOMAS MORTON ELEMENTARY SCHOOL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19142-3101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-596-8100
Provider Business Practice Location Address Fax Number:
215-382-4405
Provider Enumeration Date:
03/26/2007