Provider First Line Business Practice Location Address:
107 S OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT CARMEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17851-2145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-339-4599
Provider Business Practice Location Address Fax Number:
866-876-8987
Provider Enumeration Date:
02/23/2007