Provider First Line Business Practice Location Address:
1600 FOWLER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERWICK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18603-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-322-7873
Provider Business Practice Location Address Fax Number:
570-322-8026
Provider Enumeration Date:
06/22/2006