Provider First Line Business Practice Location Address:
119 JOE LICK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTT TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18447-7626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-563-2759
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/22/2010