Provider First Line Business Practice Location Address:
1212 NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JIM THORPE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18229-1726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-325-4239
Provider Business Practice Location Address Fax Number:
570-325-3829
Provider Enumeration Date:
09/25/2006