Provider First Line Business Practice Location Address:
17 MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAR LIN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17951-8211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-544-9131
Provider Business Practice Location Address Fax Number:
570-544-2169
Provider Enumeration Date:
09/19/2025