Provider First Line Business Practice Location Address:
44 KINGS VILLAGE
Provider Second Line Business Practice Location Address:
KINGS VILLAGE SHOPPING CENTER
Provider Business Practice Location Address City Name:
MINERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17954-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-544-8290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2006