Provider First Line Business Practice Location Address:
1215 E. BROAD ST.
Provider Second Line Business Practice Location Address:
TAMAQUA PLAZA SHOPPING CENTER,RTE 209 SOUTH
Provider Business Practice Location Address City Name:
TAMAQUA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18252-2229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-668-6494
Provider Business Practice Location Address Fax Number:
570-668-6499
Provider Enumeration Date:
09/14/2006