Provider First Line Business Practice Location Address:
8012 FRANKFORD 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:
19136-2616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-624-1758
Provider Business Practice Location Address Fax Number:
215-624-3153
Provider Enumeration Date:
05/08/2006