Provider First Line Business Practice Location Address:
121 E 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:
19125-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-739-2057
Provider Business Practice Location Address Fax Number:
215-643-6558
Provider Enumeration Date:
01/07/2009