Provider First Line Business Practice Location Address:
318 WEST APPLEGATE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEN ARGYL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18072-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-863-3055
Provider Business Practice Location Address Fax Number:
610-863-3036
Provider Enumeration Date:
03/24/2008