Provider First Line Business Practice Location Address:
261 VILLAGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENNSDALE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17756-6605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-546-3700
Provider Business Practice Location Address Fax Number:
570-546-4941
Provider Enumeration Date:
05/18/2007