Provider First Line Business Practice Location Address:
2105 E LEHIGH AVE UNIT BC1
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:
19125-1461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-639-4478
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2021