Provider First Line Business Practice Location Address:
200 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAKELY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18447-1017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-489-6781
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/07/2006