Provider First Line Business Practice Location Address:
319 GEORGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THROOP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18512-1234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-489-2331
Provider Business Practice Location Address Fax Number:
570-489-4791
Provider Enumeration Date:
08/13/2006