Provider First Line Business Practice Location Address:
8638 ROUTE 104
Provider Second Line Business Practice Location Address:
SUITE 30
Provider Business Practice Location Address City Name:
MT PLEASANT MILLS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17853-8752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-539-2600
Provider Business Practice Location Address Fax Number:
570-539-0066
Provider Enumeration Date:
11/02/2006