Provider First Line Business Practice Location Address:
166 W LEHIGH AVE
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19133-3849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-427-3099
Provider Business Practice Location Address Fax Number:
215-427-2380
Provider Enumeration Date:
03/15/2007