Provider First Line Business Practice Location Address:
8749 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:
19136-2126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-941-7689
Provider Business Practice Location Address Fax Number:
215-941-7893
Provider Enumeration Date:
08/24/2010