Provider First Line Business Practice Location Address:
123 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIRARDVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17935-1718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-875-2271
Provider Business Practice Location Address Fax Number:
570-276-2098
Provider Enumeration Date:
01/22/2007