Provider First Line Business Practice Location Address:
171 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:
19133-3832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-425-9520
Provider Business Practice Location Address Fax Number:
215-425-9522
Provider Enumeration Date:
10/07/2009