Provider First Line Business Practice Location Address:
2220 RIDGEWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYOMISSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19610-1167
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-736-0144
Provider Business Practice Location Address Fax Number:
610-736-0926
Provider Enumeration Date:
06/13/2005