Provider First Line Business Practice Location Address:
1086 STATE ROUTE 315
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-823-7761
Provider Business Practice Location Address Fax Number:
570-822-8033
Provider Enumeration Date:
09/08/2009