Provider First Line Business Practice Location Address:
105 LAKE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE HARMONY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-722-1782
Provider Business Practice Location Address Fax Number:
570-722-4655
Provider Enumeration Date:
03/08/2006