Provider First Line Business Practice Location Address:
100 E LEHIGH AVENUE
Provider Second Line Business Practice Location Address:
STE 201 MEDICAL ARTS BUILDING
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-707-0450
Provider Business Practice Location Address Fax Number:
215-707-0451
Provider Enumeration Date:
09/01/2006