Provider First Line Business Practice Location Address:
1211 MT.COBB ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT COBB
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18436-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-689-0997
Provider Business Practice Location Address Fax Number:
570-689-4817
Provider Enumeration Date:
10/26/2010