Provider First Line Business Practice Location Address:
FIFTH STREET AND MONTGOMER
Provider Second Line Business Practice Location Address:
BOYERTOWN PROFESSIONAL CENTER
Provider Business Practice Location Address City Name:
BOYERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-369-7271
Provider Business Practice Location Address Fax Number:
610-369-7299
Provider Enumeration Date:
11/30/2006