Provider First Line Business Practice Location Address:
312 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEN ARGYL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18072-1641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-863-5214
Provider Business Practice Location Address Fax Number:
610-863-0123
Provider Enumeration Date:
08/09/2005