Provider First Line Business Practice Location Address:
512 DEKALB ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19405-1134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-787-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/06/2023