Provider First Line Business Practice Location Address:
6808 FRANKFORD AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-624-7418
Provider Business Practice Location Address Fax Number:
215-624-5499
Provider Enumeration Date:
10/05/2006