Provider First Line Business Practice Location Address:
1526 LOMBARD ST.
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:
19146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-546-5970
Provider Business Practice Location Address Fax Number:
540-361-1246
Provider Enumeration Date:
10/02/2007