Provider First Line Business Practice Location Address:
302 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLATINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18080-1537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-767-4121
Provider Business Practice Location Address Fax Number:
610-767-7386
Provider Enumeration Date:
06/09/2005