Provider First Line Business Practice Location Address:
602 ALTAMONT BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRACKVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17931-2412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-874-2033
Provider Business Practice Location Address Fax Number:
570-874-2804
Provider Enumeration Date:
01/16/2006