Provider First Line Business Practice Location Address:
101 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
COOPERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18036-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-282-1170
Provider Business Practice Location Address Fax Number:
610-282-0256
Provider Enumeration Date:
04/20/2007