Provider First Line Business Practice Location Address:
21 S MAPLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT CARMEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17851-2052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-217-7183
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/15/2024