Provider First Line Business Practice Location Address:
5 S WASHINGTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERMYN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18433-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-383-9934
Provider Business Practice Location Address Fax Number:
570-383-6258
Provider Enumeration Date:
09/07/2005