Provider First Line Business Practice Location Address:
7148 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:
19135-1018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-941-7370
Provider Business Practice Location Address Fax Number:
215-318-0220
Provider Enumeration Date:
08/31/2018