Provider First Line Business Practice Location Address:
404 RIDGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREELAND
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18224-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-704-4232
Provider Business Practice Location Address Fax Number:
570-636-0985
Provider Enumeration Date:
09/05/2006