Provider First Line Business Practice Location Address:
8848 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:
19136-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-331-1819
Provider Business Practice Location Address Fax Number:
866-866-1056
Provider Enumeration Date:
02/13/2013