Provider First Line Business Practice Location Address:
75 YELLOW RUN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JIM THORPE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18229-2704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-778-4742
Provider Business Practice Location Address Fax Number:
570-325-8687
Provider Enumeration Date:
01/26/2009