Provider First Line Business Practice Location Address:
5006 BALTIMORE AVE
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:
19143-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-748-1000
Provider Business Practice Location Address Fax Number:
215-748-4715
Provider Enumeration Date:
03/08/2013