Provider First Line Business Practice Location Address:
121 S. MEMORIAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAVERTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-696-3868
Provider Business Practice Location Address Fax Number:
570-696-3541
Provider Enumeration Date:
04/23/2012