Provider First Line Business Practice Location Address:
1300 W LEHIGH AVE STE 102
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:
19132-2760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-659-8088
Provider Business Practice Location Address Fax Number:
215-228-9099
Provider Enumeration Date:
11/06/2019