Provider First Line Business Practice Location Address:
6604 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:
19135-2509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-266-8844
Provider Business Practice Location Address Fax Number:
856-245-7764
Provider Enumeration Date:
07/13/2011