Provider First Line Business Practice Location Address:
138 S MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT CARMEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17851-2232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-339-3423
Provider Business Practice Location Address Fax Number:
570-339-2367
Provider Enumeration Date:
08/29/2006