Provider First Line Business Practice Location Address:
1025 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MATAMORAS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18336-1713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-491-5702
Provider Business Practice Location Address Fax Number:
570-491-5728
Provider Enumeration Date:
08/17/2006