Provider First Line Business Practice Location Address:
1001 BALTIMORE PIKE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-604-0439
Provider Business Practice Location Address Fax Number:
610-604-0509
Provider Enumeration Date:
05/16/2006