Provider First Line Business Practice Location Address:
246 S LEHIGH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRACKVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-874-3002
Provider Business Practice Location Address Fax Number:
570-874-2829
Provider Enumeration Date:
11/22/2006