Provider First Line Business Practice Location Address:
1212 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWOYERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-287-5588
Provider Business Practice Location Address Fax Number:
570-287-3799
Provider Enumeration Date:
10/27/2006