Provider First Line Business Practice Location Address:
649 S GARFIELD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRACKVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17931-2427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-874-2125
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/14/2011