Provider First Line Business Practice Location Address:
415 DELAWARE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-897-7437
Provider Business Practice Location Address Fax Number:
570-897-2514
Provider Enumeration Date:
10/23/2006