Provider First Line Business Practice Location Address:
39 SOUTH RIVER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-822-9514
Provider Business Practice Location Address Fax Number:
570-823-8039
Provider Enumeration Date:
10/02/2006