Provider First Line Business Practice Location Address:
120 PENN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17752-1144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-547-1608
Provider Business Practice Location Address Fax Number:
570-547-6755
Provider Enumeration Date:
03/27/2007