Provider First Line Business Practice Location Address:
11747 ROUTE 287
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLEBURY CENTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-376-3831
Provider Business Practice Location Address Fax Number:
570-376-2370
Provider Enumeration Date:
09/11/2014