Provider First Line Business Practice Location Address:
56 MAUCH CHUNK 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:
18252-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-668-6366
Provider Business Practice Location Address Fax Number:
570-668-9019
Provider Enumeration Date:
07/17/2006