Provider First Line Business Practice Location Address:
680 FREDERICK ST
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:
17745-3119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-560-3417
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2011