Provider First Line Business Practice Location Address:
1001 WASHINGTON AVE
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:
18067-2005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-262-5134
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2007