Provider First Line Business Practice Location Address:
143 SCHOOL LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAIRDSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17742-0034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-584-2605
Provider Business Practice Location Address Fax Number:
570-329-4947
Provider Enumeration Date:
12/28/2005