Provider First Line Business Practice Location Address:
564 FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAMBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19526-1116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-562-5562
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2005