Provider First Line Business Practice Location Address:
217 W LEHIGH AVE
Provider Second Line Business Practice Location Address:
STORE #2
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19133-3421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-279-7981
Provider Business Practice Location Address Fax Number:
267-687-7662
Provider Enumeration Date:
02/14/2012