Provider First Line Business Practice Location Address:
540 E 11TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BERWICK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18603-2247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-752-6641
Provider Business Practice Location Address Fax Number:
570-784-5730
Provider Enumeration Date:
12/30/2005