Provider First Line Business Practice Location Address:
360 WHITE DEER RUN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALLENWOOD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17810-0097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-255-2335
Provider Business Practice Location Address Fax Number:
570-538-5303
Provider Enumeration Date:
08/26/2005