Provider First Line Business Practice Location Address:
8002 FRANKFORD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILA
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:
215-338-7645
Provider Business Practice Location Address Fax Number:
215-613-5047
Provider Enumeration Date:
04/08/2014