Provider First Line Business Practice Location Address:
809 JEFFERSON STREET
Provider Second Line Business Practice Location Address:
POST OFFICE BOX 783
Provider Business Practice Location Address City Name:
WHITEHALL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18052-5525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-585-8157
Provider Business Practice Location Address Fax Number:
610-266-8040
Provider Enumeration Date:
07/02/2007