Provider First Line Business Practice Location Address:
241 MARKET STREET STATE HWY 209
Provider Second Line Business Practice Location Address:
BOX #42
Provider Business Practice Location Address City Name:
CUMBOLA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17930-0042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-277-6406
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2007