Provider First Line Business Practice Location Address:
5041 5TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18436-3448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-815-0934
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2024