Provider First Line Business Practice Location Address:
3RD & ST. JAMES STREET
Provider Second Line Business Practice Location Address:
ST. JAMES COMPLEX #206B
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-662-2821
Provider Business Practice Location Address Fax Number:
570-662-2822
Provider Enumeration Date:
08/07/2009