Provider First Line Business Practice Location Address:
701 CEMETERY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY SHORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-398-7170
Provider Business Practice Location Address Fax Number:
570-398-5612
Provider Enumeration Date:
02/20/2007