Provider First Line Business Practice Location Address:
223 W BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMAQUA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18252-1834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-668-3194
Provider Business Practice Location Address Fax Number:
570-668-0840
Provider Enumeration Date:
01/17/2008