Provider First Line Business Practice Location Address:
1 PARK LANE CENTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOUGLASSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-385-7403
Provider Business Practice Location Address Fax Number:
610-385-7558
Provider Enumeration Date:
08/04/2006