Provider First Line Business Practice Location Address:
1716 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAKELY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-342-3314
Provider Business Practice Location Address Fax Number:
570-342-3315
Provider Enumeration Date:
01/09/2019