Provider First Line Business Practice Location Address:
408 E BROAD ST
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:
18252-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-668-0290
Provider Business Practice Location Address Fax Number:
570-668-2454
Provider Enumeration Date:
07/14/2006