Provider First Line Business Practice Location Address:
565 W PENN PIKE
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:
18252-5673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-225-0354
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/01/2014