Provider First Line Business Practice Location Address:
12 UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PINE GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17963-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-794-5007
Provider Business Practice Location Address Fax Number:
570-915-6525
Provider Enumeration Date:
12/23/2008