Provider First Line Business Practice Location Address:
1547 MILL CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWFOUNDLAND
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18445-5239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-983-8513
Provider Business Practice Location Address Fax Number:
570-676-4074
Provider Enumeration Date:
10/17/2019