Provider First Line Business Practice Location Address:
1540 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHAMPTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18067-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-440-0265
Provider Business Practice Location Address Fax Number:
610-440-1978
Provider Enumeration Date:
02/27/2007