Provider First Line Business Practice Location Address:
5800 WALNUT STREET, REAR
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:
19139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-474-4444
Provider Business Practice Location Address Fax Number:
215-474-6021
Provider Enumeration Date:
06/15/2015