Provider First Line Business Practice Location Address:
372 THE GLN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMIMENT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18371-9724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-588-0201
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/28/2008