Provider First Line Business Practice Location Address:
1212 LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JERSEY SHORE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17740-1920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-398-7471
Provider Business Practice Location Address Fax Number:
570-398-3520
Provider Enumeration Date:
11/07/2006