Provider First Line Business Practice Location Address:
716 DELAWARE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18351-0358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-897-6272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/03/2007