Provider First Line Business Practice Location Address:
4 S COUNTY LINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUDERTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18964-2814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
157-237-1772
Provider Business Practice Location Address Fax Number:
215-721-8771
Provider Enumeration Date:
05/26/2006