Provider First Line Business Practice Location Address:
9300 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:
19114-2861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-331-9576
Provider Business Practice Location Address Fax Number:
215-331-9577
Provider Enumeration Date:
03/22/2006