Provider First Line Business Practice Location Address:
PO BOX 43
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FACTORYVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18419-0043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-561-6639
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2025