Provider First Line Business Practice Location Address:
260 W 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:
19133-3425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-425-3784
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/19/2022