Provider First Line Business Practice Location Address:
9 S DARTMOUTH DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARSHALLS CREEK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18335-9900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-223-5630
Provider Business Practice Location Address Fax Number:
570-223-5635
Provider Enumeration Date:
12/01/2010