Provider First Line Business Practice Location Address:
963 CHESTNUT ST OFC B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KULPMONT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17834-1248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-373-1015
Provider Business Practice Location Address Fax Number:
570-373-1023
Provider Enumeration Date:
09/29/2006