Provider First Line Business Practice Location Address:
816 CENTRAL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOLLMSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-387-1832
Provider Business Practice Location Address Fax Number:
570-387-5103
Provider Enumeration Date:
06/20/2012