Provider First Line Business Practice Location Address:
72 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18651
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-779-5312
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/07/2006