Provider First Line Business Practice Location Address:
292 W RIDGE PIKE
Provider Second Line Business Practice Location Address:
BLDG B 2ND FL
Provider Business Practice Location Address City Name:
LIMERICK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19468-3716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-973-6567
Provider Business Practice Location Address Fax Number:
484-973-6573
Provider Enumeration Date:
05/18/2010