Provider First Line Business Practice Location Address:
1051 MOUNTAIN VIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEHMAN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18627-0903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-675-4545
Provider Business Practice Location Address Fax Number:
570-675-7123
Provider Enumeration Date:
08/30/2005