Provider First Line Business Practice Location Address:
306 E 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19405-1809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-275-7800
Provider Business Practice Location Address Fax Number:
610-275-6527
Provider Enumeration Date:
08/26/2006