Provider First Line Business Practice Location Address:
438 SLOCUM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWOYERSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-1947
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-332-8634
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/11/2017