Provider First Line Business Practice Location Address:
401 N FAIRVIEW ST
Provider Second Line Business Practice Location Address:
HEALTH PROFESSIONS BUILDING
Provider Business Practice Location Address City Name:
LOCK HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17745-2342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-484-2878
Provider Business Practice Location Address Fax Number:
750-484-2200
Provider Enumeration Date:
12/14/2011