Provider First Line Business Practice Location Address:
685 ISLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCK HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17745-8844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-748-2678
Provider Business Practice Location Address Fax Number:
570-748-4015
Provider Enumeration Date:
08/10/2005