Provider First Line Business Practice Location Address:
9627 ROUTE 35
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT MILLS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17853-8409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-524-4446
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2007