Provider First Line Business Practice Location Address:
1001 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHAMPTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-262-6721
Provider Business Practice Location Address Fax Number:
610-262-7593
Provider Enumeration Date:
11/24/2006