Provider First Line Business Practice Location Address:
9122 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:
19114-2860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-331-1516
Provider Business Practice Location Address Fax Number:
215-331-8149
Provider Enumeration Date:
05/15/2014