Provider First Line Business Practice Location Address:
123 WEST ACADEMY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUGHESVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-584-2772
Provider Business Practice Location Address Fax Number:
570-584-2446
Provider Enumeration Date:
10/18/2006