Provider First Line Business Practice Location Address:
301 MOREA RD
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:
17932-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-773-2158
Provider Business Practice Location Address Fax Number:
570-783-2002
Provider Enumeration Date:
11/29/2007