Provider First Line Business Practice Location Address:
8012 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:
19136-2616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-516-6830
Provider Business Practice Location Address Fax Number:
215-333-2748
Provider Enumeration Date:
07/15/2006