Provider First Line Business Practice Location Address:
1007A 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:
19133-1641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-715-2099
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2023