Provider First Line Business Practice Location Address:
17350 OLD TURNPIKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILLMONT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17845-9334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-922-3351
Provider Business Practice Location Address Fax Number:
570-922-3391
Provider Enumeration Date:
03/19/2007