Provider First Line Business Practice Location Address:
401 MELMORE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLD FORGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18518-1647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-457-8391
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2006