Provider First Line Business Practice Location Address:
712 CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-6947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-954-8308
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2009