Provider First Line Business Practice Location Address:
93 W STATE ROUTE 61
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT CARMEL
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17851-2508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-339-4513
Provider Business Practice Location Address Fax Number:
570-339-4680
Provider Enumeration Date:
03/14/2006