Provider First Line Business Practice Location Address:
101 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHILDS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18407-2905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-281-9201
Provider Business Practice Location Address Fax Number:
570-281-9185
Provider Enumeration Date:
04/04/2006