Provider First Line Business Practice Location Address:
101-105 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIRARDVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17935
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-276-1261
Provider Business Practice Location Address Fax Number:
570-276-1001
Provider Enumeration Date:
06/24/2005