Provider First Line Business Practice Location Address:
14 STOUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YATESVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18640-3321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-543-2830
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2026