Provider First Line Business Practice Location Address:
4320 5TH STREET HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19560-1740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-939-2644
Provider Business Practice Location Address Fax Number:
844-411-6758
Provider Enumeration Date:
03/10/2010