Provider First Line Business Practice Location Address:
209 HUNTER ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLEN RIDDLE LIMA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19037-0073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-565-2228
Provider Business Practice Location Address Fax Number:
610-565-1178
Provider Enumeration Date:
09/05/2006