Provider First Line Business Practice Location Address:
4148 KUTZTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19560-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-375-0395
Provider Business Practice Location Address Fax Number:
610-685-7849
Provider Enumeration Date:
07/20/2006