Provider First Line Business Practice Location Address:
6921 FRANKFORD AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19135-1623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-332-3240
Provider Business Practice Location Address Fax Number:
215-332-3241
Provider Enumeration Date:
08/29/2006