Provider First Line Business Practice Location Address:
283 2ND ST PK
Provider Second Line Business Practice Location Address:
STE - 145
Provider Business Practice Location Address City Name:
SOUTHAMPTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-494-2255
Provider Business Practice Location Address Fax Number:
215-494-2258
Provider Enumeration Date:
08/11/2008