Provider First Line Business Practice Location Address:
3560 ROUTE 611
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
BARTONSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18321-9386
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-421-2896
Provider Business Practice Location Address Fax Number:
570-421-6267
Provider Enumeration Date:
10/26/2009