Provider First Line Business Practice Location Address:
713 E. BASIN ROAD E-123
Provider Second Line Business Practice Location Address:
WILLIAM PENN HS WELLNESS CENTER
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19720
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-423-9035
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2010