Provider First Line Business Practice Location Address:
39 S TULPEHOCKEN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINE GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17963-1102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-617-4944
Provider Business Practice Location Address Fax Number:
570-915-6199
Provider Enumeration Date:
11/10/2014