Provider First Line Business Practice Location Address:
301 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VALLEY VIEW
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17983-0186
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-682-3145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2005