Provider First Line Business Practice Location Address:
1325 N RIVER ST
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
PLAINS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702-1838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-824-6620
Provider Business Practice Location Address Fax Number:
570-824-6621
Provider Enumeration Date:
08/21/2006