Provider First Line Business Practice Location Address:
3180 ROUTE 611
Provider Second Line Business Practice Location Address:
SUITE 22
Provider Business Practice Location Address City Name:
BARTONSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18321-7824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-629-1700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2005