Provider First Line Business Practice Location Address:
1161 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JENKINS TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18640-1557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-905-2803
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2020