Provider First Line Business Practice Location Address:
430 W SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SLATINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18080-1723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-509-6070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2017