Provider First Line Business Practice Location Address:
827 SOUTH HUMER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENOLA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-594-2128
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2012