Provider First Line Business Practice Location Address:
1321 ALLEGHENY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY SHORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-398-9861
Provider Business Practice Location Address Fax Number:
570-389-9867
Provider Enumeration Date:
06/03/2022