Provider First Line Business Practice Location Address:
138 N MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAZARETH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-759-7224
Provider Business Practice Location Address Fax Number:
610-759-7424
Provider Enumeration Date:
08/28/2006