Provider First Line Business Practice Location Address:
1095 DETURKSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINE GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17963-7947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-345-6237
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/21/2006