Provider First Line Business Practice Location Address:
56 MAIN ST STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NICHOLSON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-942-8700
Provider Business Practice Location Address Fax Number:
570-942-8702
Provider Enumeration Date:
06/23/2006