Provider First Line Business Practice Location Address:
4301 5TH STREET HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19560-1739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-208-8801
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2024