Provider First Line Business Practice Location Address:
412 W. LEHIGH AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-765-2272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2016