Provider First Line Business Practice Location Address:
12 KIRBY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAIN TOP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18707-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-474-5980
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2006