Provider First Line Business Practice Location Address:
4900 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:
19124-2618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-831-2086
Provider Business Practice Location Address Fax Number:
215-831-5944
Provider Enumeration Date:
12/20/2012