Provider First Line Business Practice Location Address:
241 MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
DICKSON CITY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18519-1654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-383-5300
Provider Business Practice Location Address Fax Number:
570-383-9202
Provider Enumeration Date:
11/08/2006