Provider First Line Business Practice Location Address:
842 MCALPINE STREET
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
AVOCA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18641-1104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-842-9323
Provider Business Practice Location Address Fax Number:
570-842-9362
Provider Enumeration Date:
12/30/2014