Provider First Line Business Practice Location Address:
695 E. 16TH ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BERWICK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-759-1833
Provider Business Practice Location Address Fax Number:
570-759-0314
Provider Enumeration Date:
07/06/2005