Provider First Line Business Practice Location Address:
550 SPRUCE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KULPMONT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17834-1424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-349-4054
Provider Business Practice Location Address Fax Number:
866-399-0991
Provider Enumeration Date:
01/27/2022