Provider First Line Business Practice Location Address:
137 COLLEGE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FACTORYVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18419-7719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-802-6499
Provider Business Practice Location Address Fax Number:
570-910-2020
Provider Enumeration Date:
02/24/2016