Provider First Line Business Practice Location Address:
1080 BLAKESLEE BOULEVARD DR E
Provider Second Line Business Practice Location Address:
ROUTE 443
Provider Business Practice Location Address City Name:
LEHIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18235-8753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-377-1942
Provider Business Practice Location Address Fax Number:
610-377-3070
Provider Enumeration Date:
01/26/2006