Provider First Line Business Practice Location Address:
101 W 7TH ST
Provider Second Line Business Practice Location Address:
SUITE 2-F
Provider Business Practice Location Address City Name:
PENNSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18073-1512
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-679-3197
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/10/2007