Provider First Line Business Practice Location Address:
2602 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:
19132-3120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-687-2702
Provider Business Practice Location Address Fax Number:
267-687-2707
Provider Enumeration Date:
08/26/2011