Provider First Line Business Practice Location Address:
1623 ROUTE 507
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-676-5660
Provider Business Practice Location Address Fax Number:
570-676-0457
Provider Enumeration Date:
09/29/2006