Provider First Line Business Practice Location Address:
1111 FORTY FOOT ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KULPSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19443-0220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-362-8166
Provider Business Practice Location Address Fax Number:
215-368-4235
Provider Enumeration Date:
09/01/2010