Provider First Line Business Practice Location Address:
2901 W LEHIGH 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:
19132-1810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-228-8782
Provider Business Practice Location Address Fax Number:
215-227-5803
Provider Enumeration Date:
10/12/2005