Provider First Line Business Practice Location Address:
RR 1 BOX 1083
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KUNKLETOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18058-9695
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-325-1033
Provider Business Practice Location Address Fax Number:
610-770-3452
Provider Enumeration Date:
02/21/2007