Provider First Line Business Practice Location Address:
726 CHURCH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FOGELSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18051-0864
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-395-8800
Provider Business Practice Location Address Fax Number:
610-530-8940
Provider Enumeration Date:
07/18/2006