Provider First Line Business Practice Location Address:
201 W 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST GREENVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18041-1509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-679-7961
Provider Business Practice Location Address Fax Number:
215-679-5906
Provider Enumeration Date:
09/12/2006