Provider First Line Business Practice Location Address:
1100 E NORTHAMPTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL RUN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18706-9520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-533-7705
Provider Business Practice Location Address Fax Number:
954-781-7173
Provider Enumeration Date:
02/21/2018