Provider First Line Business Practice Location Address:
303 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONYNGHAM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-788-1344
Provider Business Practice Location Address Fax Number:
570-788-3346
Provider Enumeration Date:
10/25/2006