Provider First Line Business Practice Location Address:
229 W. LEHIGH AVE.
Provider Second Line Business Practice Location Address:
SUITE 201-FL2
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:
215-914-6917
Provider Business Practice Location Address Fax Number:
215-914-6972
Provider Enumeration Date:
06/21/2016