Provider First Line Business Practice Location Address:
1186 CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOSCOW
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18444-9346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-842-5131
Provider Business Practice Location Address Fax Number:
570-842-5126
Provider Enumeration Date:
07/28/2006