Provider First Line Business Practice Location Address:
410 W STATE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERTZTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19539-9600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-682-2194
Provider Business Practice Location Address Fax Number:
610-682-2195
Provider Enumeration Date:
11/20/2006