Provider First Line Business Practice Location Address:
111 W LEAMY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19064-2306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-938-6009
Provider Business Practice Location Address Fax Number:
610-938-6270
Provider Enumeration Date:
12/15/2006