Provider First Line Business Practice Location Address:
3005 STATE ROUTE 235
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLMONT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17845-9561
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-922-1120
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/14/2005