Provider First Line Business Practice Location Address:
17 NORTH 23RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PENN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-779-8394
Provider Business Practice Location Address Fax Number:
610-779-8396
Provider Enumeration Date:
12/27/2006