Provider First Line Business Practice Location Address:
144 DAVENPORT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLYMOUTH
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18651-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-846-0676
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2019