Provider First Line Business Practice Location Address:
46 MIFFLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINE GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17963-1318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-345-3495
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2007