Provider First Line Business Practice Location Address:
10 E SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRACKVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17931-2418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-874-4289
Provider Business Practice Location Address Fax Number:
570-874-1228
Provider Enumeration Date:
07/22/2006