Provider First Line Business Practice Location Address:
189 FRANKLIN MILLS BLVD
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:
19154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-871-4005
Provider Business Practice Location Address Fax Number:
570-955-0267
Provider Enumeration Date:
07/26/2011