Provider First Line Business Practice Location Address:
104 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FACTORYVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18419-2808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-945-9556
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2006