Provider First Line Business Practice Location Address:
113 SHADY LANE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH ABINGTON TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18411-9020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-586-5726
Provider Business Practice Location Address Fax Number:
570-587-2008
Provider Enumeration Date:
03/15/2007