Provider First Line Business Practice Location Address:
39 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAZARETH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18064-2037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-365-8990
Provider Business Practice Location Address Fax Number:
610-365-8991
Provider Enumeration Date:
01/17/2007