Provider First Line Business Practice Location Address:
101-103 E. LEHIGH AVE.
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19125-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-427-0405
Provider Business Practice Location Address Fax Number:
215-427-0138
Provider Enumeration Date:
10/17/2005