Provider First Line Business Practice Location Address:
98 N RAILROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMAQUA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18252-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-668-3342
Provider Business Practice Location Address Fax Number:
570-668-3504
Provider Enumeration Date:
07/31/2006