Provider First Line Business Practice Location Address:
RR 3 BOX 130
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KUNKLETOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18058-9519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-365-8373
Provider Business Practice Location Address Fax Number:
610-365-8373
Provider Enumeration Date:
02/23/2012