Provider First Line Business Practice Location Address:
7 W BETHANY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWMANSTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17073-9191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-757-1153
Provider Business Practice Location Address Fax Number:
610-757-1154
Provider Enumeration Date:
07/15/2011