Provider First Line Business Practice Location Address:
1143 NORTHERN BLVD # 165
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH ABINGTON TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18411-2221
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-903-4337
Provider Business Practice Location Address Fax Number:
570-266-5666
Provider Enumeration Date:
10/23/2026