Provider First Line Business Practice Location Address:
5615 W GIRARD AVE
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:
19131-4128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-477-5800
Provider Business Practice Location Address Fax Number:
215-477-5800
Provider Enumeration Date:
12/13/2011