Provider First Line Business Practice Location Address:
233 SCHOOL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KINTNERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-218-3918
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2007