Provider First Line Business Practice Location Address:
8716 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:
19136-1315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-331-0200
Provider Business Practice Location Address Fax Number:
215-338-7788
Provider Enumeration Date:
02/21/2008