Provider First Line Business Practice Location Address:
6609 FRANKFORD AVENUE
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:
19135-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-624-0344
Provider Business Practice Location Address Fax Number:
215-624-3887
Provider Enumeration Date:
08/01/2006