Provider First Line Business Practice Location Address:
382 EPPS ST
Provider Second Line Business Practice Location Address:
BOX 266
Provider Business Practice Location Address City Name:
WIND GAP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18091-9717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-863-8598
Provider Business Practice Location Address Fax Number:
610-863-0267
Provider Enumeration Date:
07/19/2005