Provider First Line Business Practice Location Address:
3560 OLD ROUTE 22
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-562-6002
Provider Business Practice Location Address Fax Number:
570-621-4560
Provider Enumeration Date:
11/14/2006