Provider First Line Business Practice Location Address:
1300 W LEHIGH AVE
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19132-2764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-223-1018
Provider Business Practice Location Address Fax Number:
215-223-1019
Provider Enumeration Date:
07/24/2020