Provider First Line Business Practice Location Address:
313-327 W BALD EAGLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCK HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-748-1790
Provider Business Practice Location Address Fax Number:
570-748-7631
Provider Enumeration Date:
02/17/2022