Provider First Line Business Practice Location Address:
3565 ROUTE 611
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BARTONSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18321-7832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-424-9455
Provider Business Practice Location Address Fax Number:
570-424-9456
Provider Enumeration Date:
11/19/2010