Provider First Line Business Practice Location Address:
590 COAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHIGHTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18235-1339
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-377-9730
Provider Business Practice Location Address Fax Number:
610-377-9510
Provider Enumeration Date:
08/19/2011