Provider First Line Business Practice Location Address:
236 EAST MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOGANTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-725-7822
Provider Business Practice Location Address Fax Number:
570-725-7825
Provider Enumeration Date:
11/30/2006