Provider First Line Business Practice Location Address:
161 WEST FIRST ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIFFLINVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-759-9918
Provider Business Practice Location Address Fax Number:
570-759-1139
Provider Enumeration Date:
04/11/2006