Provider First Line Business Practice Location Address:
6542 LEBANON 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:
19151-3328
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-877-2400
Provider Business Practice Location Address Fax Number:
215-877-2403
Provider Enumeration Date:
04/27/2012