Provider First Line Business Practice Location Address:
13 RESERVOIR ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCELHATTAN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-769-7629
Provider Business Practice Location Address Fax Number:
570-769-7630
Provider Enumeration Date:
10/26/2006