Provider First Line Business Practice Location Address:
281 NORTH 12TH STREET
Provider Second Line Business Practice Location Address:
STE 2B
Provider Business Practice Location Address City Name:
LEHIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18235-1101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-377-0990
Provider Business Practice Location Address Fax Number:
610-377-2099
Provider Enumeration Date:
12/16/2005