Provider First Line Business Practice Location Address:
1258 PURDYTOWN TPKE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18438-6793
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-470-6190
Provider Business Practice Location Address Fax Number:
570-226-1967
Provider Enumeration Date:
06/08/2011