Provider First Line Business Practice Location Address:
2127 S 1ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEHALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18052-4824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-264-2353
Provider Business Practice Location Address Fax Number:
610-264-0834
Provider Enumeration Date:
06/10/2005