Provider First Line Business Practice Location Address:
4912 SHANKWEILER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OREFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18069-2305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-395-6322
Provider Business Practice Location Address Fax Number:
610-398-9880
Provider Enumeration Date:
07/02/2006