Provider First Line Business Practice Location Address:
42 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JENKINS TOWNSHIP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18640-3103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-540-9316
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2025