Provider First Line Business Practice Location Address:
120 S HIGHLAND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOCK HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17745-2812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-748-7173
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/31/2015