Provider First Line Business Practice Location Address:
501 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLD FORGE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-457-4099
Provider Business Practice Location Address Fax Number:
570-457-7205
Provider Enumeration Date:
07/31/2006