Provider First Line Business Practice Location Address:
231 S TULPEHOCKEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINE GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17963-1037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-345-0188
Provider Business Practice Location Address Fax Number:
570-345-0267
Provider Enumeration Date:
02/26/2007