Provider First Line Business Practice Location Address:
7729 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOGELSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-366-0717
Provider Business Practice Location Address Fax Number:
610-366-0635
Provider Enumeration Date:
10/06/2006