Provider First Line Business Practice Location Address:
1714 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAKELY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18447-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-351-3089
Provider Business Practice Location Address Fax Number:
570-489-1464
Provider Enumeration Date:
06/21/2008