Provider First Line Business Practice Location Address:
5501 WOODLAND AVENUE
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:
19143
Provider Business Practice Location Address Country Code:
UM
Provider Business Practice Location Address Telephone Number:
215-724-4700
Provider Business Practice Location Address Fax Number:
215-724-3111
Provider Enumeration Date:
07/01/2005