Provider First Line Business Practice Location Address:
130 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLAKELY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18447-1232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-383-4900
Provider Business Practice Location Address Fax Number:
570-383-4901
Provider Enumeration Date:
05/12/2006