Provider First Line Business Practice Location Address:
2848 W LEHIGH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19132-3130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-228-7177
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2007