Provider First Line Business Practice Location Address:
1048 LITZELMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUSHORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18614-8059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-928-1098
Provider Business Practice Location Address Fax Number:
570-928-1098
Provider Enumeration Date:
12/19/2017