Provider First Line Business Practice Location Address:
403 LAUREL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUGHESTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-602-3044
Provider Business Practice Location Address Fax Number:
570-602-3045
Provider Enumeration Date:
03/31/2006