Provider First Line Business Practice Location Address:
7125 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:
19135-1008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-338-8900
Provider Business Practice Location Address Fax Number:
215-338-8923
Provider Enumeration Date:
05/30/2006