Provider First Line Business Practice Location Address:
24 S 14TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUAKERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18951-1147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-957-6411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2009