Provider First Line Business Practice Location Address:
260 DALEVILLE HWY
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
COVINGTON TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18444-7951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-842-7746
Provider Business Practice Location Address Fax Number:
570-842-7189
Provider Enumeration Date:
05/31/2006