Provider First Line Business Practice Location Address:
938 PENN AVENUE
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:
19610-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-372-0466
Provider Business Practice Location Address Fax Number:
610-372-9142
Provider Enumeration Date:
09/14/2005