Provider First Line Business Practice Location Address:
134 W THIRD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIFFLINVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-752-4504
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2007