Provider First Line Business Practice Location Address:
2660 LEFEVRE ST
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:
19137-2044
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-850-5701
Provider Business Practice Location Address Fax Number:
215-535-4115
Provider Enumeration Date:
04/13/2016