Provider First Line Business Practice Location Address:
1214 LINE ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUNBURY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17801-1677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-245-1526
Provider Business Practice Location Address Fax Number:
570-254-0028
Provider Enumeration Date:
05/28/2010