Provider First Line Business Practice Location Address:
1580 CENTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JIM THORPE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18229-1012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-325-2705
Provider Business Practice Location Address Fax Number:
484-403-4054
Provider Enumeration Date:
02/13/2007