Provider First Line Business Practice Location Address:
2601 HOLME AVENUE
Provider Second Line Business Practice Location Address:
NAZARETH HOSPITAL, GME OFFICE,3RD FLOOR MARIAN BUILDING
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-350-7401
Provider Business Practice Location Address Fax Number:
267-350-7441
Provider Enumeration Date:
05/19/2026