Provider First Line Business Practice Location Address:
7339 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:
19136-3929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-809-2396
Provider Business Practice Location Address Fax Number:
215-331-2122
Provider Enumeration Date:
01/17/2013