Provider First Line Business Practice Location Address:
9627 ROUTE 35
Provider Second Line Business Practice Location Address:
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:
17853-8409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-539-2561
Provider Business Practice Location Address Fax Number:
570-539-2702
Provider Enumeration Date:
10/11/2007