Provider First Line Business Practice Location Address:
4510 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:
19124-3602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-744-1302
Provider Business Practice Location Address Fax Number:
215-744-2544
Provider Enumeration Date:
07/15/2015