Provider First Line Business Practice Location Address:
201 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREEN LANE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-941-4663
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2008