Provider First Line Business Practice Location Address:
211 N 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18235-1138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-377-7008
Provider Business Practice Location Address Fax Number:
310-377-7920
Provider Enumeration Date:
11/03/2006