Provider First Line Business Practice Location Address:
340 NORTH MIDDLETOWN RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN RIDDLE LIMA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-891-5860
Provider Business Practice Location Address Fax Number:
610-891-6438
Provider Enumeration Date:
11/30/2005