Provider First Line Business Practice Location Address:
122 SILVER LAKE RD
Provider Second Line Business Practice Location Address:
MIDDLETOWN HIGH SCHOOL
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19709-1225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-378-5775
Provider Business Practice Location Address Fax Number:
302-378-5760
Provider Enumeration Date:
02/28/2011