Provider First Line Business Practice Location Address:
CORNER OLD TRAIL AND MILL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUMMELS WHARF
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-743-4523
Provider Business Practice Location Address Fax Number:
570-743-4504
Provider Enumeration Date:
06/10/2005