Provider First Line Business Practice Location Address:
701 W OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRACKVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17931-1672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-874-4100
Provider Business Practice Location Address Fax Number:
570-874-4182
Provider Enumeration Date:
03/24/2006