Provider First Line Business Practice Location Address:
219 CLAREMONT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMAQUA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18252-4431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-668-1889
Provider Business Practice Location Address Fax Number:
570-668-6115
Provider Enumeration Date:
09/29/2005