Provider First Line Business Practice Location Address:
413 BRIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEISSPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18235-2213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-379-9304
Provider Business Practice Location Address Fax Number:
610-379-9308
Provider Enumeration Date:
11/16/2007