Provider First Line Business Practice Location Address:
4609 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:
19124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-744-7161
Provider Business Practice Location Address Fax Number:
215-744-7456
Provider Enumeration Date:
05/21/2008