Provider First Line Business Practice Location Address:
MS 26 20
Provider Second Line Business Practice Location Address:
100 N. ACADEMY AVENUE
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17822-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-214-4862
Provider Business Practice Location Address Fax Number:
570-271-6701
Provider Enumeration Date:
12/01/2005