Provider First Line Business Practice Location Address:
408 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WATSONTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17777-1620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-538-2893
Provider Business Practice Location Address Fax Number:
209-391-4521
Provider Enumeration Date:
07/11/2005