Provider First Line Business Practice Location Address:
184 WATERTON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHICKSHINNY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-951-6534
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2006