Provider First Line Business Practice Location Address:
190 WELLES ST STE 122
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORTY FORT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-4961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-718-4140
Provider Business Practice Location Address Fax Number:
570-718-4141
Provider Enumeration Date:
10/02/2008