Provider First Line Business Practice Location Address:
260 LAKE WARREN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER BLACK EDDY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18972-9621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
267-424-5666
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/19/2008