Provider First Line Business Practice Location Address:
2516 E 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:
19125-3833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-426-9223
Provider Business Practice Location Address Fax Number:
215-426-9313
Provider Enumeration Date:
01/17/2007