Provider First Line Business Practice Location Address:
3560 ROUTE 611
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
BARTONSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18321-9451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-421-2785
Provider Business Practice Location Address Fax Number:
570-424-2513
Provider Enumeration Date:
12/05/2011