Provider First Line Business Practice Location Address:
50 N MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT CARMEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17851-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-339-2156
Provider Business Practice Location Address Fax Number:
570-339-2020
Provider Enumeration Date:
02/21/2007