CITY OF PHILADELPHIA

NPI # 

Practice Address:

4400 Haverford Ave

Philadelphia, PA, 19104-1361

Practice Phone:

215-685-7628

Practice Fax:

215-685-6848

License State:

PA

Taxonomy Grouping:

Ambulatory Health Care Facilities

Taxonomy Classification:

Clinic/Center

Taxonomy Specialization:

Federally Qualified Health Center (FQHC)

Taxonomy Code:

261QF0400X