Provider First Line Business Practice Location Address:
800 MICKLEY RUN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEHALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18052-7997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-770-0601
Provider Business Practice Location Address Fax Number:
610-910-3955
Provider Enumeration Date:
12/20/2011