Provider First Line Business Practice Location Address:
330 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17846-0260
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-458-5594
Provider Business Practice Location Address Fax Number:
570-458-4715
Provider Enumeration Date:
12/11/2006