Provider First Line Business Practice Location Address:
881 THIRD STREET
Provider Second Line Business Practice Location Address:
SUITE A 2
Provider Business Practice Location Address City Name:
WHITEHALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18052-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-266-9048
Provider Business Practice Location Address Fax Number:
610-266-0250
Provider Enumeration Date:
11/09/2006