Provider First Line Business Practice Location Address:
647 STATE ROUTE 93 SUITE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONYNGHAM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18219-1174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-788-1163
Provider Business Practice Location Address Fax Number:
570-788-0114
Provider Enumeration Date:
07/07/2010