Provider First Line Business Practice Location Address:
139 E LEHIGH AVE
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:
19125-1011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-423-9708
Provider Business Practice Location Address Fax Number:
215-423-4173
Provider Enumeration Date:
07/07/2006