Provider First Line Business Practice Location Address:
930 BELLEFONTE AVE
Provider Second Line Business Practice Location Address:
NWD PLAZA, SUITE 105
Provider Business Practice Location Address City Name:
LOCK HAVEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17745-2754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-748-7072
Provider Business Practice Location Address Fax Number:
570-748-7084
Provider Enumeration Date:
07/27/2006