Provider First Line Business Practice Location Address:
845 WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHUMBERLAND
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17857-1243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-473-3912
Provider Business Practice Location Address Fax Number:
540-473-8731
Provider Enumeration Date:
03/20/2006