Provider First Line Business Practice Location Address:
100 E LEHIGH AVE
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19125-1012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-707-9311
Provider Business Practice Location Address Fax Number:
215-707-9313
Provider Enumeration Date:
12/05/2006