Provider First Line Business Practice Location Address:
5501 WOODLAND 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:
19143-5607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-724-4700
Provider Business Practice Location Address Fax Number:
215-724-3111
Provider Enumeration Date:
08/07/2018