Provider First Line Business Practice Location Address:
5 MOUNTAIN MALL
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SHICKSHINNY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18655-1227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-542-2420
Provider Business Practice Location Address Fax Number:
570-542-2396
Provider Enumeration Date:
11/20/2006