Provider First Line Business Practice Location Address:
109 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLOR
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18517-1415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-562-0421
Provider Business Practice Location Address Fax Number:
570-986-0005
Provider Enumeration Date:
08/30/2006