Provider First Line Business Practice Location Address:
930 WASHINGTON 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:
19147-3840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-627-8000
Provider Business Practice Location Address Fax Number:
215-627-9265
Provider Enumeration Date:
12/03/2016