Provider First Line Business Practice Location Address:
UNIVERSITY AND WOODLAND AVE.
Provider Second Line Business Practice Location Address:
VA MECICAL CENTER, MENTAL HEALTH CLINIC, 7TH FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-823-4038
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/15/2006