Provider First Line Business Practice Location Address:
5 COURTYARD OFFICES
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
SELINSGROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17870-9374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-743-1140
Provider Business Practice Location Address Fax Number:
570-743-7252
Provider Enumeration Date:
01/17/2006