Provider First Line Business Practice Location Address:
144 MIFFLIN ST
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:
19148-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-694-0967
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2016