Provider First Line Business Practice Location Address:
2101 W LEHIGH AVE STE A
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:
19132-2664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-628-6117
Provider Business Practice Location Address Fax Number:
786-870-4039
Provider Enumeration Date:
03/13/2018