Provider First Line Business Practice Location Address:
534 LEVERINGTON AVE
Provider Second Line Business Practice Location Address:
APT 1
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19128-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-241-2900
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2012