Provider First Line Business Practice Location Address:
136 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
QUAKAKE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18245-0136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-956-5642
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2014