Provider First Line Business Practice Location Address:
29 DEPOT STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PECKVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18452-2323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-383-7233
Provider Business Practice Location Address Fax Number:
570-489-2802
Provider Enumeration Date:
08/24/2006