Provider First Line Business Practice Location Address:
1731 COCHECTON TURNPIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAMASCUS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18415-0105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-224-6700
Provider Business Practice Location Address Fax Number:
570-224-6649
Provider Enumeration Date:
07/17/2007