Provider First Line Business Practice Location Address:
561 FAIRTHORNE AVE.
Provider Second Line Business Practice Location Address:
FAIRMOUNT BEHAVIORAL HEALTH SYSTEM
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-582-3405
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/01/2008