Provider First Line Business Practice Location Address:
111 S SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAZARETH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18064-2155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-746-9640
Provider Business Practice Location Address Fax Number:
610-746-9642
Provider Enumeration Date:
04/07/2006