Provider First Line Business Practice Location Address:
5501 OLD YORK RD # LIFTER1
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:
19141-3018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-456-7405
Provider Business Practice Location Address Fax Number:
215-456-7403
Provider Enumeration Date:
03/27/2017