Provider First Line Business Practice Location Address:
190 FOSTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREELAND
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18224-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-636-2728
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2006