Provider First Line Business Practice Location Address:
301 FREDERICK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCK HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17745-3815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-748-4660
Provider Business Practice Location Address Fax Number:
570-748-2026
Provider Enumeration Date:
06/21/2006