Provider First Line Business Practice Location Address:
23 FIREHOUSE WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AVONDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19311-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-268-2486
Provider Business Practice Location Address Fax Number:
610-268-3573
Provider Enumeration Date:
01/11/2006