Provider First Line Business Practice Location Address:
17 ELIZABETH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORTY FORT
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:
570-287-8661
Provider Business Practice Location Address Fax Number:
570-287-0192
Provider Enumeration Date:
01/18/2007