Provider First Line Business Practice Location Address:
1170 HIGHWAY 315 BLVD STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-6906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-654-2883
Provider Business Practice Location Address Fax Number:
570-883-9709
Provider Enumeration Date:
08/23/2005