Provider First Line Business Practice Location Address:
259 ALLEGHENY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY SHORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17740-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-567-5418
Provider Business Practice Location Address Fax Number:
570-666-3074
Provider Enumeration Date:
01/28/2021