Provider First Line Business Practice Location Address:
48 S OAK 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:
17851-2156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-339-3721
Provider Business Practice Location Address Fax Number:
570-339-3691
Provider Enumeration Date:
03/28/2011