Provider First Line Business Practice Location Address:
930 WASHINGTON 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:
19147-3840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-339-3000
Provider Business Practice Location Address Fax Number:
215-336-4742
Provider Enumeration Date:
06/30/2010