Provider First Line Business Practice Location Address:
5 SOUTH CENTER AVE.
Provider Second Line Business Practice Location Address:
204
Provider Business Practice Location Address City Name:
LEESPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-926-9659
Provider Business Practice Location Address Fax Number:
610-926-9456
Provider Enumeration Date:
11/16/2007