Provider First Line Business Practice Location Address:
3199 ROUTE 611
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARTONSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18321-7808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-629-6829
Provider Business Practice Location Address Fax Number:
866-584-6408
Provider Enumeration Date:
07/11/2006