Provider First Line Business Practice Location Address:
363 BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
NEW BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16242-1304
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-275-4030
Provider Business Practice Location Address Fax Number:
814-275-4483
Provider Enumeration Date:
03/31/2011