Provider First Line Business Practice Location Address:
161 GREAT BEND TPKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLEASANT MOUNT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18453-4596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-448-2963
Provider Business Practice Location Address Fax Number:
570-448-3105
Provider Enumeration Date:
05/24/2006