Provider First Line Business Practice Location Address:
106 DEKALB ST
Provider Second Line Business Practice Location Address:
FIRST FLOOR
Provider Business Practice Location Address City Name:
BRIDGEPORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19405-1056
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-272-4181
Provider Business Practice Location Address Fax Number:
610-272-5313
Provider Enumeration Date:
04/14/2011