Provider First Line Business Practice Location Address:
27811 ROUTE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18810-9653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-882-9009
Provider Business Practice Location Address Fax Number:
570-882-9011
Provider Enumeration Date:
12/06/2005