Provider First Line Business Practice Location Address:
845 WATER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHUMBERLAND
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17857-0064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-473-3912
Provider Business Practice Location Address Fax Number:
570-473-8731
Provider Enumeration Date:
06/19/2009