Provider First Line Business Practice Location Address:
3600 GRANT 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:
19114-2630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-677-0400
Provider Business Practice Location Address Fax Number:
215-677-5181
Provider Enumeration Date:
11/06/2012