Provider First Line Business Practice Location Address:
MAIN AND KING STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAPORTE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-265-2525
Provider Business Practice Location Address Fax Number:
570-265-1075
Provider Enumeration Date:
03/11/2011