Provider First Line Business Practice Location Address:
8828 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:
19136-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-338-4010
Provider Business Practice Location Address Fax Number:
215-338-4060
Provider Enumeration Date:
12/08/2011