Provider First Line Business Practice Location Address:
1214 LINE ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SUNBURY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17801-1677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-991-6376
Provider Business Practice Location Address Fax Number:
570-991-6377
Provider Enumeration Date:
02/18/2010