Provider First Line Business Practice Location Address:
2121 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:
19132-2654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-226-6479
Provider Business Practice Location Address Fax Number:
215-226-6501
Provider Enumeration Date:
05/25/2014