Provider First Line Business Practice Location Address:
9910 FRANKFORD AVE
Provider Second Line Business Practice Location Address:
MORRELL PLAZA
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19114-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-632-2636
Provider Business Practice Location Address Fax Number:
215-632-2639
Provider Enumeration Date:
02/01/2013