Provider First Line Business Practice Location Address:
110 DELAWARE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLYPHANT
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18447-1518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-487-4447
Provider Business Practice Location Address Fax Number:
570-487-2750
Provider Enumeration Date:
06/16/2006