Provider First Line Business Practice Location Address:
134 W 3RD ST
Provider Second Line Business Practice Location Address:
POB G
Provider Business Practice Location Address City Name:
MIFFLINVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-752-4504
Provider Business Practice Location Address Fax Number:
570-752-2430
Provider Enumeration Date:
01/05/2006