Provider First Line Business Practice Location Address:
1050 BALTIMORE PIKE
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19064-2853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-543-5996
Provider Business Practice Location Address Fax Number:
610-543-5129
Provider Enumeration Date:
05/22/2007