Provider First Line Business Practice Location Address:
547 CANTON STREET
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-297-2970
Provider Business Practice Location Address Fax Number:
570-297-5057
Provider Enumeration Date:
08/11/2006