Provider First Line Business Practice Location Address:
102 SOUTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BETHLEHEM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16242-1238
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-275-2264
Provider Business Practice Location Address Fax Number:
814-275-7875
Provider Enumeration Date:
05/18/2012