Provider First Line Business Practice Location Address:
111 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VANDLING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18421-1711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-785-3194
Provider Business Practice Location Address Fax Number:
570-785-9775
Provider Enumeration Date:
12/05/2006