Provider First Line Business Practice Location Address:
BEECH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAPORTE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18626-0115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-946-4547
Provider Business Practice Location Address Fax Number:
570-946-4829
Provider Enumeration Date:
09/13/2006