Provider First Line Business Practice Location Address:
420 MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDWARDSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18704-3232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-287-8893
Provider Business Practice Location Address Fax Number:
570-288-7810
Provider Enumeration Date:
12/05/2006