Provider First Line Business Practice Location Address:
7001 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:
19135-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-543-0715
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/23/2011