Provider First Line Business Practice Location Address:
400 W ALLEGHENY AVE STE B1
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:
19133-3614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-291-9200
Provider Business Practice Location Address Fax Number:
215-278-7596
Provider Enumeration Date:
06/23/2023