Provider First Line Business Practice Location Address:
384 W BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18651-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-852-9078
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2013