Provider First Line Business Practice Location Address:
513 E FAIRVIEW ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COOPERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18036-1516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-560-3433
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2013