Provider First Line Business Practice Location Address:
114 RIDGEWOOD DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FISHERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-839-9908
Provider Business Practice Location Address Fax Number:
814-839-9925
Provider Enumeration Date:
10/24/2006