Provider First Line Business Practice Location Address:
OLD RT 22
Provider Second Line Business Practice Location Address:
HAMBURG CENTER
Provider Business Practice Location Address City Name:
HAMBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-562-6006
Provider Business Practice Location Address Fax Number:
610-562-6085
Provider Enumeration Date:
04/03/2007