Provider First Line Business Practice Location Address:
528 RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19475-9681
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-495-6026
Provider Business Practice Location Address Fax Number:
610-495-1482
Provider Enumeration Date:
09/17/2006