Provider First Line Business Practice Location Address:
1094 WELSH RD
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:
19115-2805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-673-4100
Provider Business Practice Location Address Fax Number:
215-673-4200
Provider Enumeration Date:
03/01/2011