Provider First Line Business Practice Location Address:
647 S R 93
Provider Second Line Business Practice Location Address:
VALLEY PLAZA STE 7
Provider Business Practice Location Address City Name:
CONYNGHAM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18219-0752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-788-4133
Provider Business Practice Location Address Fax Number:
570-788-2876
Provider Enumeration Date:
08/09/2006