Provider First Line Business Practice Location Address:
1741 FRANKFORD AVE
Provider Second Line Business Practice Location Address:
SUITE 100-F
Provider Business Practice Location Address City Name:
PHILA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19125-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-425-2424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/02/2008