Provider First Line Business Practice Location Address:
PO BOX 84
Provider Second Line Business Practice Location Address:
1632 SINGLEY LANE
Provider Business Practice Location Address City Name:
UPPER BLACK EDDY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-534-3723
Provider Business Practice Location Address Fax Number:
551-361-9199
Provider Enumeration Date:
10/08/2024