Provider First Line Business Practice Location Address:
5201 WYNNEFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE G4
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19131-2456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-878-7100
Provider Business Practice Location Address Fax Number:
215-878-1871
Provider Enumeration Date:
12/19/2007