Provider First Line Business Practice Location Address:
43 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17752-1120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-547-0480
Provider Business Practice Location Address Fax Number:
570-547-0498
Provider Enumeration Date:
05/09/2006