Provider First Line Business Practice Location Address:
12 ORTEGA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMAQUA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18252-4511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-668-2339
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/20/2006