Provider First Line Business Practice Location Address:
139 W BROAD ST
Provider Second Line Business Practice Location Address:
SUITE 102-CARES
Provider Business Practice Location Address City Name:
TAMAQUA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18252-1960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-778-0797
Provider Business Practice Location Address Fax Number:
570-225-7360
Provider Enumeration Date:
09/14/2013