Provider First Line Business Practice Location Address:
401 SUSQUEHANNA AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCK HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-893-2781
Provider Business Practice Location Address Fax Number:
570-893-2220
Provider Enumeration Date:
10/23/2006