Provider First Line Business Practice Location Address:
2301 E ALLEGHENY AVE
Provider Second Line Business Practice Location Address:
NORTHEASTERN HOSPITAL
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19134-4427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-291-3617
Provider Business Practice Location Address Fax Number:
215-291-3702
Provider Enumeration Date:
06/02/2008