Provider First Line Business Practice Location Address:
141 WALLACE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNINGTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19335-2957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-269-2797
Provider Business Practice Location Address Fax Number:
610-269-3962
Provider Enumeration Date:
07/19/2005