Provider First Line Business Practice Location Address:
615 ROUTE 973 EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COGAN STATION
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17728-9116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-494-0411
Provider Business Practice Location Address Fax Number:
570-494-2148
Provider Enumeration Date:
05/25/2006