Provider First Line Business Practice Location Address:
3600 GRANT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19114-2630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-677-0400
Provider Business Practice Location Address Fax Number:
215-671-1837
Provider Enumeration Date:
07/15/2005