Provider First Line Business Practice Location Address:
205 CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
BERWICK
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18603-3817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-752-2985
Provider Business Practice Location Address Fax Number:
570-752-2987
Provider Enumeration Date:
01/03/2013