Provider First Line Business Practice Location Address:
112 W LEAMY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19064-2312
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-328-2320
Provider Business Practice Location Address Fax Number:
610-757-4031
Provider Enumeration Date:
05/20/2011