Provider First Line Business Practice Location Address:
1006 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:
19133-1640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-225-7522
Provider Business Practice Location Address Fax Number:
215-225-7525
Provider Enumeration Date:
02/01/2007