Provider First Line Business Practice Location Address:
3110 GRANT AVENUE
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:
19114-2542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-464-6600
Provider Business Practice Location Address Fax Number:
215-464-2379
Provider Enumeration Date:
06/02/2006