Provider First Line Business Practice Location Address:
220 CLAREMONT AVE
Provider Second Line Business Practice Location Address:
SUITE #2
Provider Business Practice Location Address City Name:
TAMAQUA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18252-4434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-668-1900
Provider Business Practice Location Address Fax Number:
570-668-8812
Provider Enumeration Date:
02/28/2011