Provider First Line Business Practice Location Address:
8 N GROVE ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LOCK HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17745-3547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-858-5645
Provider Business Practice Location Address Fax Number:
570-858-5687
Provider Enumeration Date:
11/16/2005