Provider First Line Business Practice Location Address:
4304 5TH STREET HWY UNIT 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19560-1740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-220-2912
Provider Business Practice Location Address Fax Number:
610-929-2472
Provider Enumeration Date:
08/09/2005