Provider First Line Business Practice Location Address:
PA ROUTE 313
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
FOUNTAINVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18923-0175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-345-0822
Provider Business Practice Location Address Fax Number:
215-345-7571
Provider Enumeration Date:
06/11/2007