Provider First Line Business Practice Location Address:
115 PENN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENNSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-664-3786
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2012