Provider First Line Business Practice Location Address:
1834 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAKELY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18447-1370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-489-4432
Provider Business Practice Location Address Fax Number:
570-489-8083
Provider Enumeration Date:
08/30/2006